Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

PRIVATE BUSINESS

BRITISH RAILWAYS (NO. 2) BILL

Order for consideration read.

To be considered on Thursday.

Oral Answers to Questions — EMPLOYMENT

Legionnaire's Disease

Mr. Janner: To ask the Secretary of State for Employment what estimate he has made of how many additional Health and Safety Executive inspectors will be needed to enforce the rules designed to eliminate Legionnaire's disease.

The Secretary of State for Employment (Mr. Norman Fowler): The Health and Safety Executive does not consider that additional inspectors are needed specifically for the enforcement of precautions against Legionnaire's disease.

Mr. Janner: Does the Minister accept that the recent disaster at the BBC, which caused the death of at least two employees and grave danger within the corporation and to passers-by, could easily be repeated? Is he aware that the executive has not enough inspectors to pay proper, regular visita to vast establishments, including those which, like the BBC, have cooling towers? What steps does he propose to take to minimise the likelihood of the spread of what could be a devastating disease?

Mr. Fowler: As I have already said, the Health and Safety Executive does not consider that additional inspectors are needed in that kind of case. The investigation into the BBC by the Health and Safety Executive is still under way and we have to await the outcome. Obviously, any lessons learnt will be acted upon. The prime responsibility in such cases rests with the employers. There has been new HSE guidance on Legionnaire's disease, and I understand that the BBC was aware of it. That, of course, is one of the matters that we shall need to examine.

Single European Market

Mr. Alfred Morris: To ask the Secretary of State for Employment what representations he has received concerning the impact of the single European market on health and safety.

The Minister of State, Department of Employment (Mr. John Cope): I have not received any direct representations. However, the Health and Safety Commission and Executive consult very widely on matters concerning health and safety at work.

Mr. Morris: When the Secretary of State meets his counterparts in the EEC, will he insist that British machinery guard standards must become the norm and will not be reduced to the lower levels found in other European countries? If he fails to do that, are not machinery guarding accidents likely to increase after 1992?

Mr. Cope: The general arrangement is that European Commission directives lay down minimum standards, but national Governments may have higher ones. Generally speaking our health and safety standards are higher than those in many other European countries, and our national regulations set levels that are higher than the minimum laid down. Of course, that can apply to machinery guard standards as well, but it is important that, as far as possible, there are equal standards across the Common Market so as to have proper competition between the countries.

Sir John Farr: I am satisfied to a certain extent with what my hon. Friend has said, but, because we have higher standards, is there not the risk that after 1992 they may be eroded?

Mr. Cope: Our standards cannot be eroded below the level on which the House may decide in legislation. As far as possible, we are anxious that there should be high standards throughout the Community.

Mr. Meacher: Is the Minister aware that there is widespread concern that the Government will use the excuse of the single European market for further health and safety deregulation? Already, the major and fatal accident rate has risen by 12 per cent. during the past six years, not least because the Government have cut the Factory Inspectorate by no less than 20 per cent. during the same period. Will he, for once, use the European legislation to level up standards and give a commitment that he will introduce the mandatory occupational health provision that Britain—alone among its European competitors—still lacks?

Mr. Cope: The hon. Gentleman will be aware of the Control of Substances Harzardous to Health Regulations which are coming forward and go some way to do what he suggests. The hon. Gentleman is wrong about fatalities. The number of fatalities in 1986–87, the latest year for which we have figures, is the lowest on record.

TUC

Mr. Bowis: To ask the Secretary of State for Employment when he last met the Trades Union Congress; and what matters were discussed.

Mr. Fowler: I last met representatives of the Trades Union Congress on Wednesday 18 May, when we discussed the new programme, employment training, which will be launched on 5 September. As a result of that meeting, the general council of the TUC decided to give the employment training programme its support.

Mr. Bowis: I am grateful to my right hon. Friend for that answer. Was he able to commiserate with the TUC at the failure of the TGWU, NALGO and NUPE to support the TUC on that line? Does not the attitude of those unions show a callous disregard for the interests of the unemployed who need to be trained for tomorrow's job world?

Mr. Fowler: I certainly believe that the opposition to employment training which came from one or two unions is wholly disreputable and contrary to the interests of long-term unemployed people. Employment training will provide training for about 600,000 people a year at a cost of about £1·5 billion. The programme will go ahead in September and I very much hope that the Opposition will stop wobbling on this issue and give it their backing.

Mr. Allen: When the Secretary of State meets the TUC, will he discuss its document relating to 1992 and the changes regarding the EEC? He will be more aware than anybody that the Government have dragged their feet on implementing previous EEC employment directives on health and safety, discrimination at work, workers' rights in multinational companies and a host of other subjects. Will he give the TUC guarantees that he will implement the current six draft EEC health and safety directives?

Mr. Fowler: I am happy to talk to the TUC on any subject that it wants to discuss, including 1992, but it seems to me that we in Britain will gain from a deregulated market in which job creation and opportunities for business are greatest, not which are the kind of provisions that the hon. Gentleman is talking about.

Mr. Madel: Is it the Government's view that existing trade union legislation is perfectly adequate to deal with industrial relations problems and has contributed to an improvement in industrial relations? If so, does my right hon. Friend agree that, apart from possible changes in the dock labour scheme, further trade union legislation is not necessary?

Mr. Fowler: We obviously keep trade union legislation and trade union law reform under consideration. There is no doubt that the Acts that the House has passed have contributed substantially to the improvement in industrial relations in Britain. We have taken a step-by-step approach, but we shall continue to keep trade union legislation under review.

Ms. Short: When the Secretary of State met the TUC, did he discuss the current consultation on the possible abolition of wages councils? Can he tell the House what is going on? We had legislation in the previous Parliament. After consultation, it was decided to weaken protection for the lowest-paid workers in Britain. We understand that there is now consultation with employers and a threat to the remaining protection for 2 million of the poorest-paid people in Britain. May we know what is planned?

Mr. Fowler: We certainly did not discuss the wages councils. They are kept under review, as the hon. Lady knows. I think that what she has in mind is a review which has been carried out, not by the Government, but by the Confederation of British Industry.

Mr. Bevan: Will my right hon. Friend confirm the severity of the damage that will be felt if the TGWU and NUPE do not come in and discuss these matters and join

the approval situation and how it will particularly have a very adverse effect on the opportunities offered by the tourism industry?

Mr. Fowler: I deplore what the TGWU and one or two other unions are doing in this respect. It seems to me that it is in no one's interests that unions should come out and oppose what is——

Ms. Short: A rotten scheme.

Mr. Fowler: —by any standards a major programme for the long-term unemployed. Those who, like the hon. Member for Birmingham, Ladywood (Ms. Short), egg the unions on carry a disreputable and heavy responsibility. The employment training programme will go on because the Government are not prepared to turn their back on the long-term unemployed.

Lead (Code of Practice)

Mr. Patchett: To ask the Secretary of State for Employment whether he will extend to men the approved code of practice for the Control of Lead at Work Regulations 1980.

The Parliamentary Under-Secretary for Employment (Mr. Patrick Nicholls): The approved code of practice for the Control of Lead at Work Regulations 1980 already applies to both men and women.

Mr. Patchett: Is the Minister aware that recent studies in the United States and the United Kingdom have shown that lead can damage the fertility of men as well as of women workers?

Mr. Nicholls: I appreciate that there has been speculation along those lines. Obviously, we keep those matters under review, but our best information at present is that men are properly protected on the basis of 70 microgrammes per 100 ml of blood. If there were proper evidence to the contrary, we would consider it.

Ms. Richardson: Does not the Minister always hide under the cloak of equality when lowering standards of health and safety at work? He removes protective legislation from women, whereas he should be leaving that legislation for women and ensuring, across the board, that it is extended to men. We are in favour of equality for both the sexes, not just one.

Mr. Nicholls: The short answer to the hon. Lady's question is no, but obviously there is a biological difference between men and women and those factors are taken into account when deciding what the correct lead levels should be. Women of reproductive capacity have to be protected, and that poses different medical and biological implications from those posed by the protection of men.

YTS

Mr. Hardy: To ask the Secretary of State for Employment what proportion of young people completing YTS in 1987 in the Rotherham-Mexborough travel-to-work area secured full-time employment.

The Parliamentary Under-Secretary of State for Employment (Mr. John Lee): The information is not available in the form requested. However, the latest results from the Training Commission's complete, 100 per cent.


follow-up survey of YTS leavers show that, of those young people who completed their YTS schemes in the Sheffield, Rotherham and Doncaster local authority districts, between April 1986 and December 1987, just over half—54 per cent—were in full-time employment.

Mr. Hardy: That is bad enough, but it seems better than the reality on the ground. Does the Minister accept that the lack of opportunity for the young people in our travel-to-work area, particularly in the Dearne valley, is deplorable and utterly disgraceful? Does he accept that in the second half of 1988 it is outrageous that three quarters of our YTS leavers of 1987 still lack full-time employment?

Mr. Lee: I certainly accept that the employment situation in the hon. Gentleman's constituency and surrounding areas is more difficult than in other parts of the country, but, even in that area, unemployment has come down from 21·2 per cent. in May 1987 to 18·8 per cent. in May 1988. As the hon. Gentleman knows, my right hon. Friend the Prime Minister recently set out a whole range of measures to help employment in the area, including urban programme grants, derelict land grants and funding from the European Community. The regional directors of the Departments of Employment, of the Environment and of Trade and Industry are working closely together to try to improve the situation. It is improving.

Mr. Patnick: Is my hon. Friend aware of Sheffield city council's decision not to implement the adult training scheme? What effect will that have on young people, and what can be done to ensure that those who want training obtain it, despite Sheffield city council's inaction?

Mr. Lee: The decision by the Sheffield authority is deplorable and can only harm those who need training to give them employment opportunities.

Mr. Hardy: On a point of order, Mr. Speaker. In view of the grossly unsatisfactory answer from the Minister, I beg to give notice that I shall seek to raise the matter on the Adjournment at the earliest opportunity.

TUC

Mr. Robert G. Hughes:: To ask the Secretary of State for Employment if he has any plans to meet the general secretary of the Trades Union Congress to discuss industrial relations; and if he will make a statement.

Mr. Fowler: I have no present plans to have such a meeting. Over the last three years there has been a substantial improvement in industrial relations, with both fewer working days lost and fewer strikes.

Mr. Hughes: When my right hon. Friend has a further meeting with the TUC general secretary, will he point out to him the importance of single union agreements in attracting inward investment to Britain, as Ford in Dundee has found? Will he stress to the TUC that British jobs are more important than the petty inter-union squabbles that are going on at present?

Mr. Fowler: I entirely agree with my hon. Friend. Such deals recognise that it is in everyone's interest that the business should be run profitably and free of strikes. I hope that the TUC will campaign so that we never see a repeat

of the action which took place at Dundee, which deprived hundreds of unemployed people of jobs, rather than campaign against single union deals.

Mr. Heffer: Is it not clear that our anti-trade union legislation is worse than any such legislation in any other European country, and is in line with what happens in Poland under General Jaruzelski? Is it not clear also that it is even worse than the legislation in the United States? Is it not about time that the Government stopped putting their foot on the neck of the ordinary working class and the trade union movement and began to accept that freedom of association, freedom to strike and freedom to have independent trade unions are as important in this country as is in Poland?

Mr. Fowler: What the hon. Gentleman has said is absurd. We have turned our back on the disastrous years of the 1970s when bad industrial relations and strikes exported British job after British job. That is the record of the previous Labour Government. Under this Government the number of strikes has reduced. The number of days lost through industrial action have also reduced dramatically.

Mr. Ian Taylor: When my right hon. Friend has an opportunity to meet the general secretary of the TUC, will he discuss with him the excellent training that the EETPU provides for its members? One of its schools is in my constituency. Will he tell the general secretary that that is one of the responsible roles that trade unions should be pursuing?

Mr. Fowler: I entirely agree with my hon. Friend. A number of unions, such as the electricians and the engineers, have excellent training facilities. It is one of the areas in which trade unions should concentrate their efforts if they want to win members.

Single European Market

Dr. Thomas:: To ask the Secretary of State for Employment what studies are being made by his Department on the implications for the levels of employment in the regions of the United Kingdom of the completion of the European single market in 1992.

Mr. Cope: We are assessing the impact of the single European market on a continuing basis. It will provide great opportunities for business throughout the United Kingdom and should therefore have a beneficial effect on jobs. The impact in different regions in the United Kingdom cannot be predicted at this stage. It depends among other things on how well companies respond to the opportunities that are there.

Dr. Thomas: I accept that the Minister has no responsibility for what Lord Cockfield may say in his capacity as a European Commissioner, but is he aware that during a visit to north Wales over the weekend Lord Cockfield stated that 60,000 new jobs would be created in Wales as a result of the single market? Is it not about time that the United Kingdom Government and other member state Governments quantified the regional impact of the single market? Will the right hon. Gentleman accept that most of the studies that have been prepared relate to


sectoral changes or changes in specific areas of the economy, and that the overall regional impact has not been assessed properly in any member state?

Mr. Cope: With respect to the noble Lord, it seems extremely difficult to make accurate predictions for individual regions. We can all guess what it might be. The Cecchini report, which was produced for the Common Market as a whole, suggests that there might be an extra 1·25 million to 2·25 million jobs over five to six years. That is vague enough for a report that covers the entire Community, let alone individual regions.

Mr. Batiste: Does my hon. Friend agree that European and other investors seeking to make green field investments in Britain will be interested primarily in the availability of single-union, no-strike agreements? Given the persecution of the electricians by the dinosaurs of the TUC, what assurance can my hon. Friend offer to European investors in future?

Mr. Cope: Assurance comes from individual unions that are far-sighted enough to see what is required.

Mr. Ron Brown: Is it the case that in 1992 the poll tax will be imposed uniformly throughout the Common Market? Of course it will not, but such ideas are floated, and it is a tax which will benefit the rich at the expense of the poor. Will the Minister leave this special Chamber and come to Scotland for a change, and meet the working class, who are organising, through the anti-poll tax unions, to fight back on the basis of non-payment? Will the Minister come to see reality for a change? Does he understand that on a Scottish, European and Socialist basis, there is a fight-back taking place, and I hope that the parliamentary Labour party will participate in it as well?

Mr. Cope: Just because I have the name of Johnny Cope, that does not mean that I am frightened to come to Scotland. I was there a few weeks ago.

Mr. Forth: Will my hon. Friend confirm that the aims and objectives of the free market, which will be of great benefit throughout, are completely inimical to the nonsenses of regional policy, which are long since discredited? Will he reiterate that the best hope for employment throughout the United Kingdom and Europe is the truly free movement of goods and capital, when Governments will no longer try to force goods and capital to go to regions or anywhere else?

Mr. Cope: Yes, we want the free movement of goods and capital, as my hon. Friend said.

Health and Safety Executive

Mr. Bradley: To ask the Secretary of State for Employment what steps he has taken to ensure that the research and laboratory services division of the Health and Safety Executive is able to carry out its responsibilities adequately.

Mr. Nicholls: I am satisfied that the Health and Safety Executive's research and laboratories division is able to carry out its responsibilities effectively. The management of the division is a matter for the executive.

Mr. Bradley: In the light of the Minister's amazingly complacent answer, will he confirm that over the past six years the number of the division's scientific and technical

officers has been reduced from 390 to 300, and that none of the £6·7 million announced last December will be used by the Government to rectify that appalling situation?

Mr. Nicholls: As I said, the way in which the Health and Safety Executive uses the moneys allocated to it is a matter for the executive, and it is for the executive to carry out its day-to-day responsibilities. If the hon. Gentleman is referring to the provision in its entirety, I am bound to tell him that the provision made by this Government certainly matches in real terms that made by our predecessors.

Mr. Meacher: How can the Minister justify a 24 per cent. cut in the Health and Safety Executive's scientific and technical staff over the past six years? How can he justify the fact that, as was said by my hon. Friend, as a result of the cut of 90 members of staff there is almost no research being undertaken into regulating low-output radiation from VDUs, which can cause foetal damage in pregnant women; that almost no research is being undertaken into establishing the known relationship between leukaemia and living near electricity power lines; and that, almost a year after the Zeebrugge disaster, almost no research is being undertaken into preventing the capsizing of cross-Channel ferries, when it is already known that Government tests show that 80 per cent. of those ferries are unsafe and do not meet international safety standards?

Mr. Nicholls: I remind the hon. Gentleman that we are dealing with employment questions rather than with transport questions. The mistake that he makes is the same as that which he made on radio this morning. He assumes that he can judge safety simply by looking at the number of people who may be employed. He does not seem to be able to get to grips with the fact that there are other dimensions to the argument, including proper, efficient working practices. There is no doubt in our minds that the research and laboratories division is able to carry out its responsibilities effectively.
I should like to think that the hon. Gentleman approaches the subject of power lines on the basis of research that is a little deeper than simply watching the last "Panorama" programme and then framing his opinions accordingly. If his research had been a little deeper, he would know that the CEGB is already carrying out research into that subject.

Industrial Action

Mr. David Martin: To ask the Secretary of State for Employment how many working days were lost due to industrial action in 1987–88; what trend this figure shows in relation to 1986–87; and if he will make a statement.

Mr. Fowler: Two and a half million working days were lost through strikes in the year to March 1988. This compares with 3·3 million and 2·5 million in the previous two financial years. These are the best results since 1967. A major reason for this improvement has been the Government's reform of trade union law.

Mr. Martin: Does my right hon. Friend agree that those figures provide yet more evidence of the success of the Government's industrial relations policy, which has brought about benefits not only for ordinary trade unionists but for members of the public, to whom the disruption of a decade ago is like a dark age to which no one wishes to return?

Mr. Fowler: I entirely agree with my hon. Friend. Last year 2·5 million working days were lost compared with an average of 13 million days a year in the 1970s, and in the manufacturing industry the average number of working days lost per employee in 1987 was almost one tenth of its 1970s average. Again, that shows the justification for and result of the Government's reform of trade union legislation.

Mrs. Fyfe: Has the Minister made any estimates of the number of working people who should be on strike but are putting up with intolerable conditions because of the repressive measures passed four times over by the Tory Government?

Mr. Fowler: Not only have industrial relations in Britain improved radically, but, fortunately, employment has, with unemployment coming down in every region. The only people who talk against that are the Labour Front-Bench spokesmen.

YTS

Mr. Ground: To ask the Secretary of State for Employment if he will make a further statement on the progress of the two-year YTS.

Mr. Cope: At the end of May 1988 there were 371,400 young people training on two-year YTS. Fifty-four per cent. of trainees entering their second year on the scheme have already gained a vocational qualification. The latest survey results show that when young people leave YTS, 75 per cent. go into jobs or into further education and training.

Mr. Ground: How does the figure of 75 per cent. of YTS trainees going into jobs or education compare with the figures for the Hounslow area and for Feltham and Heston?

Mr. Cope: For the Hounslow local authority district, which includes the Feltham constituency, the YTS follow-up survey results show that of those who left the youth training scheme between April 1986 and December 1987, 80 per cent. went into employment and a further 8 per cent. went into further education or training.

Mr. Steinberg: Is the Minister aware that in the northern region 40 per cent. of youngsters are on YTS and yet only 10 per cent. obtain full-time work when they leave? The northern region has the highest number of youngsters going back on to the dole with—the Minister can shake his head but these are true facts—more than 30 per cent. going back on to the dole compared with 12 per cent. in the south-east. Does the Minister think that the training that the youngsters are getting is worth while, or is YTS a complete and utter waste of time?

Mr. Cope: Most of the young people who go on the training say that it is worth while when we ask them at the end of their training, and that applies in all parts of the country. I cannot confirm the figures that the hon. Gentleman gave at the beginning of his question, but they did not sound correct to me.

Mr. Burns: Is my hon. Friend aware that the figures that he has given the House today will be warmly welcomed in Chelmsford, where employers are suffering from a worker famine and they see this as a commitment

to investment in the future? Is he also aware that one of the major employers in Chelmsford, the English Electric Valve company, is having great difficulty in finding employees for 300 places because there are not enough skilled people to take on? The Government's programme will not help that company in the immediate future, but it lays the foundations that will ensure that there is no recurrence of the problem in the future.

Mr. Cope: I am interested to hear the position in Chelmsford and I am glad to know that YTS is making a contribution. It sounds as though the employment training programe will too.

Mr. Sheerman: The Government know that the Labour party supports all training measures that meet national training needs in a serious way, but we find today's statement on youth training amazingly complacent, when Sainsburys are pulling out of YTS in many parts of the country and the youth training board points out that 100,000 youngsters—16 to 17-year-olds—a year go into dead-end jobs with no training at all. What are the youth training board and the Government doing about that?

Mr. Cope: An increasing number of youngsters are going into youth training and getting qualifications on the youth training scheme. Sainsburys is organising its own scheme. That is fair enough; it is entitled to do so. I am not quite sure what the hon. Gentleman meant by the remark s at the beginning of his question. If he was saying that he, and Labour Front-Bench Members are in favour of employment training, I am glad to hear it.

Mr. Wells: Does my right hon. Friend agree that the antagonism displayed by various Opposition Members to the YTS scheme explains, to a large extent, why in the northern areas that they represent YTS has not gained such acceptance or met with such success in bringing people full-time or even part-time employment? Are they not responsible for the fact that people are not properly employed in their areas?

Mr. Cope: I am sure that they bear a proportion of the responsibility.

Agricultural and Factory Inspectorates

Mr. O'Brien: To ask the Secretary of State for Employment by what date he expects to fulfil his commitment to increase the agricultural and factory inspectors by 40 inspectors additional to those in place on 2 December 1987.

Mr. Nicholls: The Health arid Safety Executive plans to increase the number of factory inspectors in the inspectorate to around 588 by 31 March 1989 and to increase the number of agricultural inspectors in the inspectorate to around 160 by 31 March 1989.

Mr. O'Brien: Since his statement on 2 December last year, is the Minister aware that instead of progress being made, there are already 15·5 per cent. fewer agricultural and factory inspectors in the inspectorate, and that resignations are greater than recruitments? Is the Minister not disappointed with the abysmal policies that he is bringing before the House? Is he not aware that those policies will add to the accidents and injuries if something is not done to speed up the recruitment of inspectors?

Mr. Nicholls: I can well understand the hon. Gentleman's concern. Although the figures announced at the end of last year worked on the assumption that there would not be the wastage that has occurred since in terms of inspectors leaving the inspectorate, the figures that I gave show precisely the same net increase, so the position is as it was announced last year.

Mr. Charles Wardle: Does not a successful record of health and safety at work depend first and foremost on the determination of operators to abide by safety rules, which exist in the great majority of companies because of Government vigilance? Most accidents occur because safety rules are ignored, not because they do not exist, or because machine guards are not available.

Mr. Nicholls: My hon. Friend is entirely right. When talking about resources and inspector numbers, it is all too easy to forget that the prime responsibility for health and safety must lie with employers and employees. I am sure that my hon. Friend is entirely right to remind us of that.

Mr. Strang: When will the Government recognise that there are now many more, smaller, dangerous workplaces to be inspected, there are many more self-employed people, for whom the inspectorate has responsibility, and above all, that under this Government, the inspectorate has been given many more responsibilities, including responsibility for gas appliances, the implementation of the new pesticide regulations and the transportation of hazardous substances? Is not Government behaviour the height of complacency when, against that background, a considerable number of inspectors are continuing to resign? There is some doubt about the Government achieving even the increase of 40 in the factory and agricultural inspectorates. When will the Government give the Health and Safety Executive the money it needs to halt the rate of resignations among inspectors?

Mr. Nicholls: I more than appreciate the hon. Gentleman's concern, but it is not complacency to make the point that one cannot say that there is a direct trade-off between the number of inspectors employed and the number of accidents that occur. As my hon. Friend the Member for Bexhill and Battle (Mr. Wardle) said a moment ago, the problem is wider than that. However, if the hon. Gentleman wishes to debate on that level, if he considers inspectors as a percentage of the employees they cover he will discover that under this Government the position has remained precisely constant with the position under the Labour Government. The hon. Gentleman knows that those are the facts, but I again tell him that that is not the whole picture.

Mr. Bill Walker: Does my hon. Friend agree that many of the accidents that occur in agriculture would not be influenced by additional inspectors, because as often as not they are caused by the miscalculations of operatives, often working in isolation?

Mr. Nicholls: My hon. Friend is entirely right to draw attention to the fact that in agriculture the rate of accidents is troubling. Today, figures were announced showing that the deaths in agriculture amounted to one more than last year, but last year was the lowest on record. That is not a reason for complacency but it is a reason for putting the problem into perspective.

Health and Safety

Mr. McTaggart: To ask the Secretary of State for Employment if he has plans to seek to increase the penalties available where health and safety law has been contravened.

Mr. Eadie: To ask the Secretary of State for Employment what consultations he has had on reviewing the penalties available for contraventions of health and safety legislation.

Mr. Nicholls: It has been suggested that the maximum fines available to magistrates' courts for breaches of health and safety legislation are not high enough. My right hon. Friend the Secretary of State has sought the views of the Health and Safety Commission and is now considering with colleagues whether there is a case to be made for reviewing those penalties.

Mr. McTaggart: Does the Minister agree with the statement made by the chair of the Health and Safety Commission earlier this year to the Select Committee on Employment when he said that it was morally unacceptable that management could be fined just £200 for a death that occurs at work? Will he approach the Lord Chancellor for stiffer penalties and consider increasing the £2,000 limit that can be imposed by magistrates' courts?

Mr. Nicholls: As a reflection of the concern expressed by the chairman of the commission we started the exercise of approaching colleagues to see whether the maximum fines available to magistrates' courts could be increased. A point that is sometimes not appreciated is that the limits on fines that can be imposed relates only to the magistrates' courts. For offences tried on indictment, fines are unlimited. I am sure that the hon. Gentleman will have taken heart from two recent decisions where fines of £250,000 and £500,000 were imposed. If the magistrates feel that their powers of punishment are insufficient, they can commit to the Crown court anyway.

Mr. Eadie: I thank the Minister for his reply about consultation and investigation. However, does he accept that, since his Government believe in deterrence, one could come to the conclusion from the statistics that there is a case for extending penalties for people who contravene the health and safety regulations.

Mr. Nicholls: Again I understand the sentiments that prompt that question. I ask the hon. Gentleman to take account of the fact that before a Crown court the fines are unlimited. The problem we are discussing is whether the penalties available to a magistrate should be greater. As I have said, a consultation exercise is taking place precisely because the concerns expressed by the hon. Gentleman and his hon. Friend the Member for Glasgow, Central (Mr. McTaggart) are shared by us.

Mr. Rowe: Is it not manifest that many accidents cause enormous distress not only to the person injured but to the employer, and that in many cases a financial penalty may be much less effective than insisting on some form of retraining and re-education of both workers and employer? Is my hon. Friend confident that the list of penalties available includes such re-education?

Mr. Nicholls: I am sure that my hon. Friend is entirely right to make the point that financial penalties are one


thing, but that the degree of shame and opprobrium that particular cases can bring on employers is something of which many are conscious.

Mr. Holt: Will my hon. Friend consider the penalties and the case against employees, who often hurt themselves by refusing to use the appropriate methods laid down by their employer? There are insufficient charges brought against employees who deliberately break the rules of their employers.

Mr. Nicholls: I suspect that my hon. Friend speaks from experience. It is a fair point to make. In civil proceedings, contributory negligence can play a part. In the criminal law, there is clearly an obligation on employers and that obligation has to be met.

Health and Safety Executive

Mr. Cousins: To ask the Secretary of State for Employment what was the additional funding sought by the Health and Safety Executive for the executive during the year 1988–89.

Mr. Nicholls: The Health and Safety Executive did not seek any additional funding at the time of the 1988–89 Supply Estimates.

Mr. Cousins: Is the Minister aware that, for example, the Hospital Physicists' Association has stated that the equivalent of one Chernobyl a year is being delivered to patients in Britain from old and poorly maintained radiation equipment? Will he therefore state clearly what the Health and Safety Executive asked for in 1989–90 to deal with this and many other pressing problems?

Mr. Nicholls: I had hoped that my initial reply to the hon. Gentleman would make it clear that the Health and Safety Executive did not seek any additional funding at the time of the 1988–89 Supply Estimates. Certainly, as far as the PESC round was concerned, it made its bid there for resources and as a result of the points that it made an extra £6·7 million was introduced—something that was very much welcomed by the chairman of the commission.

Oral Answers to Questions — PRIME MINISTER

Engagements

Mrs. Clwyd: To ask the Prime Minister if she will list her official engagements for Tuesday 5 July.

The Prime Minister (Mrs. Margaret Thatcher): This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House I shall be having further meetings later today.

Mrs. Clwyd: Does the Prime Minister recall that 40 years ago Aneurin Bevan described her party as being "lower than vermin" and its policies as organised spivvery? In the light of her verminous attack on the National Health Service and her patronage of spivs in the private sector, has anything changed?

The Prime Minister: A great deal has changed for the better in the National Health Service under a Conservative Government: more resources, more doctors, more nurses,

more patients treated and more success. Yes, a great deal has changed for the better under a Conservative Government.

Mr. Cash: To ask the Prime Minister if she will list her official engagements for Tuesday 5 July.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Cash: In connection with the 40th anniversary of the National Health Service., does my right hon. Friend agree that it was a Conservative Minister of Health who, in a White Paper in 1944, introduced the basis of the Health Service; that, furthermore, it was a Labour Government who introduced prescription charges in the 1940s; and that this Government, conducting their present review, have, since 1979, increased spending on the Health Service by 39 per cent., even after inflation?

The Prime Minister: Yes, the National Health Service should be congratulated on its 40 years of achievement, the greater part of which has been conducted under a Conservative Government. Successive Conservative Governments have provided a standard of resources for the professions to deliver a standard of service undreamed of many years ago.

Mr. Kinnock: Is the Prime Minister aware that M r. Nigel Harris, the distinguished surgeon who shared a general election press conference with her last year, asked me this morning to give her a direct personal message? M r. Harris asked me to tell the Prime Minister—[HON. MEMBERS: "Question."]

Mr. Speaker: Order. I am sure that the Leader of the Opposition is asking a question.

Mr. Kinnock: Mr. Harris asked me to tell her—[HON. MEMBERS: "Question."]

Mr. Speaker: Order. A question at Question Time, please.

Mr. Kinnock: It will be well within your recall, Mr. Speaker, that I began this question "Is the Prime Minister aware". Dodges such as we are getting from the Tories do not count except to scar them in the eyes of the public.
Is the Prime Minister aware that Mr. Harris asked me to tell her that dependence on private provision is the worst possible system? It means the poor do not get the, treatment they need and the rich get treatment they do not need. Last year the Prime Minister wanted people to heed Mr. Harris. Will she heed him now?

The Prime Minister: Perhaps the right hon. Gentleman will convey to everyone who asks him the fact that the Government are entirely committed to the principle of the National Health Service—that all people should have access to the best possible medical treatment, regardless of their ability to pay. Perhaps the right hon. Gentleman will point out to Mr. Harris that the Conservative party's record in government is the clearest possible evidence of that commitment.

Mr. Kinnock: Patently, neither Mr. Harris nor others in whole areas of the medical profession will believe a word of what the Prime Minister has just said. Given the record and philosophy of her Government, is it not obvious to everyone that her intention is to create a two-tier Health Service, with a superior level for sale and an inferior level


that remains free? Why does she not heed the advice of the British Medical Association, the Select Committee on Social Services and people like Mr. Harris and provide £1 billion to £1½ billion now to avert crisis this year? If she is really committed to the Health Service, will she give that money now?

The Prime Minister: Last year the right hon. Gentleman asked for an extra £2 billion, which was to sort out all the problems of the National Health Service. An extra £2 billion has been provided this year. In fact, we are dedicating more resources than any previous Government to the Health Service. The doctors know that there are more doctors and that they are better paid; the nurses know that there are more nurses and that they are better paid and the doctors and the nurses know that they look after more patients in better hospitals than ever before. I take it that the right hon. Gentleman still accepts, like his predecessors, that people are free to spend their own money as they choose. Or is he denying that now?

Mr. Kinnock: If the Prime Minister believes that people are free to spend their money as they choose, will she tell us why she and the Chancellor did not respond to the repeated demands from the huge majority of people in this country to spend money on the Health Service instead of giving £2½ billion to the richest people in the land? If the Prime Minister has provided that extra money for the Health Service, why does she think that it was necessary for the BMA and the Select Committee this week to call for an extra £1 billion to £1½ billion to avert a crisis? I ask her again: will she provide the money now to avert a crisis this year?

The Prime Minister: The people of this country are providing more money for the Health Service out of a growing economy. The right hon. Gentleman seems to think that people have no right at all to have any money available to spend. I know that arithmetic is not the right hon. Gentleman's strong subject, but in 1978 expenditure on the National Health Service was £8 billion, whereas this year it is £23 billion. Even the right hon. Gentleman should know that that is a lot more.

Mr. Marlow: To ask the Prime Minister if she will list her official engagements for Tuesday 5 July.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Marlow: rose—[Interruption.]——

Mr. Speaker: Order. I ask the House to calm down.

Mr. Marlow: Perhaps I may change the subject, Mr. Speaker. Is it not time that we tried a more imaginative and radical approach to the problems of yobbish hooliganism and drunken violence—[Interruption.] Could we not try a little pain and humiliation—the birch and perhaps a modern version of the stocks? Would not those tried and tested punishments appeal to the liberals, the wets and the worthies as being less barbaric than the failed alternative of imprisonment——

Mr. Speaker: Briefly.

Mr. Marlow: Could we not proceed in that more enlightened and progressive direction?

The Prime Minister: Increased sentences have been provided and are available to magistrates. Many people

are now considering different forms of sentences to deal with very bad hooliganism. As part of their sentence, people should have to report to specific places under the offices of the probation service or undertake some form of community service. They should do this regularly, at weekends or at times when they might otherwise be out engaging in the hooliganism that my hon. Friend condemns. My right hon. Friend the Home Secretary has that very much in mind. I do not believe that the route that my hon. Friend proposes would meet with sufficient support to enable such measures to get through the House or with sufficient support from the whole country.

Mr. Steel: On the question of the Iranian Airbus disaster, would it not have been more prudent for the Prime Minister to confine her comments to expressions of regret and sympathy until the inquiry result was known? Why have the Government taken no initiative to bring the peace-keeping forces in the Gulf under the international legitimacy of the United Nations organisation?

The Prime Minister: The first sentence of the statement said that the British Government profoundly regretted the loss of life on the Iranian airliner and extended their deep sympathy to the bereaved. The statement went on to point out that this had been a tragedy for all concerned. One cannot put navies into the Gulf to defend shipping from attack by either side to the conflict without giving them the right to defend themselves. No one would do that.

Dame Elaine Kellett-Bowman: To ask the Prime Minister if she will list her official engagements for Tuesday 5 July.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Dame Elaine Kellett-Bowman: Is my right hon. Friend aware of the great efforts that have been made to devise a form of voluntary no-fault visitors' personal accident insurance? That would have saved my constituents who were injured at Abbeystead a great deal of heartache had it been in force four years ago. When the scheme is launched this coming Monday, will my right hon. Friend read it and consider giving it her backing and encouraging its widespread use?

The Prime Minister: I congratulate my hon. Friend on everything that she, like a number of others, has done to get such a voluntary scheme launched. Proposals for a statutory scheme have been argued for a long time. A voluntary scheme is an excellent idea and certainly would have helped the people at Abbeystead. I shall look carefully at the scheme once it is published.

Mr. Wareing: To ask the Prime Minister if she will list her official engagements for Tuesday 5 July.

The Prime Minister: I refer the hon. Gentleman to the reply that I gave some moments ago.

Mr. Wareing: Is the Prime Minister aware that today there are many nurses in this building who will have listened with interest and disgust to some of her answers? They will deliver a petition to my hon. Friend the Member for Kirkcaldy (Dr. Moonie), which he will present to the House. Among its demands is a call for full implementation and funding by the Government of the recommendations of the review body for Health Service staff in the current year. Does the right hon. Lady realise


that those nurses are here not only on their behalf but on behalf of their patients and the people who make up the health teams? Does she realise that they have come to the House looking for the first time—I fear that it will be in vain—for a spark of humanity from her?

The Prime Minister: The nurses, doctors, dentists and allied medical professions have review bodies. Wages for other groups are negotiated through other bodies. The total cost of the review body for nurses, which is funded by the people, is some £803 million this year. I remind the hon. Gentleman, and perhaps he will remind the nurses, that the last Labour Government cut nurses' pay by 21 per cent. We have increased it by 43 per cent. in real terms. The money comes from the same place from which it always comes—people's earnings.

Mr. Arbuthnot:: To ask the Prime Minister if she will list her official engagements for Tuesday 5 July.

The Prime Minister: I refer my hon. Friend to the reply that I gave some moments ago.

Mr. Arbuthnot: Will my right hon. Friend find time to congratulate Mr. Gorbachev on his political tour de force last week and on his struggle to bring Russia into the 20th century? Does she agree that until we see a real reduction in spending on defence by the Warsaw pact countries it would be unwise to relax our guard?

The Prime Minister: I gladly congratulate Mr. Gorbachev on the boldness of his vision and the resolve with which he and those who are with him are carrying it out. As far as defence is concerned, we see no evidence of any reduction in the effort to modernise the Soviet armed forces. One of the reasons why we can so readily encourage Mr. Gorbachev's effort on internal reform is that we are staunch members of NATO and we keep our own conventional and nuclear forces fully up to date.

Ms. Armstrong: To ask the Prime Minister if she will list her official engagements for Tuesday 5 July.

The Prime Minister: I refer the hon. Lady to the reply that I gave some moments ago.

Ms. Armstrong: Will the Prime Minister take this opportunity to scotch rumours that she will change the basic funding method of the National Health Service? The country and the medical profession are saying that insurance and other methods will be more expensive and much less efficient. Will she give her support to a National Health Service that is free at the point of need?

The Prime Minister: Yes, I thought that I had made it perfectly clear in answer to another question that the National Health Service will continue to be available. It is financed in two ways now: the direct taxation, and the part that is conributed together with the national insurance contributions. That is a very small part of the total finance, the rest of which comes direct from taxation.

Belfast City Council (Meeting)

Rev. Ian Paisley: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
the physical assaults mounted in the Belfast city council last night by IRA Sinn Fein members on Unionist councillors, resulting in the break-up of the council meeting and some five Unionist councillors having to receive hospital treatment.
Last night in the Belfast city council IRA Sinn Fein councillors yet again showed their true colours when they loosed their thuggery on Loyalist members. One woman councillor was thrown to the ground; an attempt was made to beat her head in with a chair. Another alderman, who had previously been shot and seriously wounded by the IRA, was viciously punched. Altogether, according to police reports, five members had to be taken to hospital—[Interruption.]

Mr. Speaker: Order. I am listening to this application.

Rev. Ian Paisley: The first blow was struck by IRA Sinn Fein member O'Mullior, and his party members McKnight, Lavery, McCann, Holland, Fitzimmons, McGuigan and Maskey all joined in. Loyalist members had been provoked by them throughout the proceedings and when violence was used against them they had no option but to defend themselves. The Alliance party spokesman in the corporation confirmed that—of course, he is not a member of either of the Unionist parties.
For the past three years Loyalist members throughout Ulster have been expected by the Government to tolerate gunmen in the council chambers. While the Government will not talk to Sinn Fein gunmen, they expect Unionist members whose friends have been murdered and whose homes have been burnt by these thugs to conduct local government business.
I call on the Government today to proscribe Sinn Fein and keep violence out of the council chambers.

Mr. Speaker: The hon. Gentleman asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,
the physical assaults mounted in Belfast council last night by IRA Sinn Fein members on Unionist councillors, resulting in the break-up of the council meeting and some five Unionist councillors having to receive hospital treatment.
I am sure that the whole House has listened with deep concern to what the hon. Gentleman has said about what went on in Belfast last night, but I regret that I do not consider the matter that he has raised as being appropriate for discussion under Standing Order No. 20, and I cannot therefore submit his application to the House.

Girobank (Privatisation)

Mr. Allan Roberts: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,

the privatisation of Girobank in the light of the Government's recent refusal to allow parliamentary scrutiny of the proposals and the circumstances of purchase.
This is a specific matter, because on 7 June the Chancellor of the Duchy of Lancaster announced that Girobank would be privatised by tender, and I raised on a point of order the fact that to privatise Girobank no legislation or parliamentary scrutiny was necessarily required. You pointed out, Mr. Speaker, that it was not for you to advise on tactics, but went on to say that there were ways of raising these matters.
We took your advice, Mr. Speaker, and sought at the request of the Bootle work force a meeting with the Secretary of State or the Chancellor of the Duchy of Lancaster. We were refused a meeting with the Ministers. We were able to secure agreement from the Trade and Industry Select Committee that it would inquire into Girobank's future, but today Ministers have made it clear that they intend to privatise Girobank before the Select Committee reports.
It was in the light of assurances about the Select Committee inquiry and parliamentary scrutiny of the privatisation proposals that the work force voted against strike action but wished to obtain through Parliament assurances about their job security and the safeguarding of Girobank's separate and continuing entity. The Government's refusal to debate or discuss the issues and the details of their privatisation proposals is an insult to Parliament, and gives credence to the belief that Ministers have already earmarked a specific financial institution to take over the bank. Why else will they not give assurances that the bank will not be sold and then asset-stripped?
The matter is urgent because it is not just about the future of 6,000 jobs on Merseyside. Giro is a national employer with regional centres. This is a national issue. It is also about the future of the nation's network of post office counters, which depend on Girobank business and are also at risk.
It seems, Mr.Speaker, that the only chance of parliamentary scrutiny is for you to grant a debate. The Government are playing Wall street roulette with 6,000 jobs on Merseyside by the way in which they are dealing with Girobank's privatisation, and they should be called to account.

Mr. Speaker: The hon. Gentleman asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,
the privatisation of Girobank in the light of the Government's recent refusal to allow parliamentary scrutiny of the proposals and the circumstances of purchase.
Once again I have to say that I have listened with great care to what the hon. Gentleman has had to say, but I do not consider the matter that he has raised as being appropriate for discussion under Standing Order No. 20, and I cannot therefore submit his application to the House.

Points of Order

Mr. Dennis Howell: On a point of order, Mr. Speaker. I wish to ask for your help or advice on the growing discourtesy of the Minister with responsibility for sport in replying to vital questions by means of written answers, and not consulting or presenting himself to the House.
You will recall, Mr. Speaker, that we had to complain about this last week in respect of the sale of local authority sports facilities. On the same day, the Minister issued another answer announcing fundamental changes in the structure of the Sports Council which not only go back on the White Paper that I presented to the House in 1975, but, in my judgment, affect the independence of the Sports Council and the right of governing bodies of the Central Council of Physical Recreation to elect their own membership, which may well be a breach of the royal charter. In this instance, the Minister concerned briefed journalists on Friday and gave a written answer on Friday, which was printed in Hansard only today. In other words, for four days hon. Members who are entitled to be consulted or informed did not receive either courtesy. Was this a breach of order, and how should we proceed in the matter?

Mr. Speaker: I can answer only about those matters for which I have responsibility. The House knows that it is in order for a Minister to reply to a written question; I have no responsibility for that. I regret that the reply that the right hon. Gentleman has in mind was not printed in Friday's Official Report. I have made inquiries about this. There have been some delays in printing answers in recent weeks, but the problems are being overcome. The answer is printed in the Official Report today. It has been available in the Library since noon on Friday last.

Mr. Tam Dalyell: On a point of order, Mr. Speaker. Anyone in your position has a great problem in the sense that, in the morning, when you come to make the decisions that we all know you have to make, you cannot know what questions the Prime Minister will be asked. You will recollect that in 1982 there were frequent statements from the Government on the rules of engagement in the war of the south Atlantic. Ought there not to be a statement on the rules of engagement in the Gulf? At Question Time the Prime Minister properly said that British forces have a right to defend themselves.
My point of order is this. Should not the House of Commons, and others, be told precisely under what rules of engagement the Armilla patrol is operating?

Mr. Speaker: The hon. Gentleman's best course is to table a question and obtain an answer to it. Perhaps I can help him further by saying that it is likely that this matter could arise at Question Time tomorrow.

Mr. Barry Porter: On a point of order, Mr. Speaker, relating to the matter raised by the hon. Member for Antrim, North (Rev. Ian Paisley). It is difficult for me, or for the House, to avoid the conclusion that had last night's events in Belfast occurred in Tottenham, Islington or Toxteth they would have been treated as a matter of national importance. Is it right that the city of Belfast and the Province of Ulster should be treated as somehow being different from the rest of the United Kingdom?

Mr. Speaker: I can say only that I have to base my judgment on Standing Order No. 20 applications on whether they meet the criteria and involve the responsibility of Her Majesty's Government. I have already given my view on that.

Mr. Tony Marlow: On a point of order, Mr. Speaker. I want genuinely to ask for your advice. Many Members of the Labour party, and I now also a Member of the Liberal party, have been wearing sticky bits of paper on their lapels. The proceedings of the House are not currently being televised, but, as we all know, a Select Committee is considering the possibility of televising the House. Will it be addressing this particular issue, because obviously it could lead to great abuse? Hon. Members could come in with little slips saying "Mars bars" on them, and be paid by an outside organisation. That sort of thing clearly should be looked at closely. I wonder whether you could tell the House whether anything is being done about this matter.

Mr. Speaker: I think that the hon. Gentleman's best course is to raise that matter himself with the Committee.

Mr. Richard Holt: On a point of order, Mr. Speaker. You will recall that last week, on a point of order, I was, to say the least, rude to you when I said that you might have been in collusion with the hon. Member for Stockton, North (Mr. Cook). I should have realised that nobody would be in collusion with the hon. Member for Stockton, North—anybody who was would be out of his mind. I wish to withdraw my remark and apologise to you, Mr. Speaker.

Mr. Speaker: I thank the hon. Gentleman for his generosity.

STATUTORY INSTRUMENTS, &c.

Mr. Speaker: By leave of the House, I shall put together the Questions on the two motions relating to statutory instruments.

Ordered,
That the draft Pesticides (Maximum Residue Levels in Food) Regulations 1988 be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft Farm Woodland Scheme 1988 be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. Lightbown.]

Gazumping (Abolition)

Mr. David Martin: I beg to move,
That leave be given to bring in a Bill to prevent gazumping in connection with buying and selling homes.
The disgraceful practice of gazumping has been raised in the House on several occasions over the years, notably by my hon. Friend the Member for Mid-Staffordshire (Mr. Heddle). It has also been the object of attention by the Law Commission and, from time to time, by the legal profession's magazines and the press. A remarkable number of right hon. and hon. Members have shared with me the experiences of their constituents, and I have been helped by them.
The word "gazump" is based on "gazoomph," which is a graphic Yiddish word meaning to swindle or to cheat. It applies when the purchaser and the vendor of a home have agreed on a definite price and then, before contracts are exchanged, the vendor raises the price to that purchaser or sells at a higher price to someone else. It does not apply to the converse case of the purchaser withdrawing before exchange of contracts. That is a nuisance and the breaking of an agreement, but it is not gazumping. I have some ideas on that, too, but I have only 10 minutes in which to speak, so they must be developed at another time.
Gazumping has been described as a method of parting rich men from their money—and it certainly does that. The greater problem is that it also parts the relatively less well off from theirs, especially young people and first-time buyers.
Scottish law and practice is far nearer to what I would like to see happen in England and Wales. It has been said that nothing stops us operating the same system. That may theoretically be true, but it will never happen without legislation.
First, my main aim it to give 14 days to a purchaser to exchange after the price has been agreed. During those 14 days, if the vendor backs out, the vendor would have to pay the purchaser 5 per cent. of the agreed price, plus any specific and reasonable costs incurred by the purchaser during that time. Any sum less than 5 per cent. would not be a deterrent, because gazumping is in multiples of thousands of pounds these days, even on less expensive property. Therefore, as in Scotland, the price would be fixed at the outset. In England and Wales exchange would follow in a short time and certainly would exist at an earlier stage. The parties could then agree either a long or short period for completion, depending significantly on the need for the purchaser to sell his or her home in the meantime.
Secondly, considerations of time would be more important. My Bill would promote a speeding up of the all too ponderous and needlessly mystifying processes of conveyancing. For all the welcome increases in home ownership in recent years, in many respects we are still in the age of the quill pen when it comes to law and practice. Solicitors, in particular, must grow more used to the idea that they are in a commercial world. Their negative attitude to advertising is revealing. The advent of licensed conveyancers has helped to bring the profession face to face with commercial reality. Many have recognised and seized the opportunities to co-operate with or to operate property shops, but more needs to be done.
Thirdly, home purchase would be helped by insisting on more, and more accurate, information in the agents' particulars. That is a subject in itself. I have seen particulars offering me
a modern system of central hating",
"gilt" spelt "guilt" and even
rent and rat free accommodation".
Fourthly, the vendor would be required to provide far more information to a purchaser when he puts his property on the market. He would be required to provide a survey from a surveyor with proper professional qualifications. No honest vendor should object to that. If the purchaser wished to be more thorough, he could obtain a further survey on his own. At the same time, the vendor would also be required to provide the usual standard searches and inquiries.
Local authorities should be able to produce all the relevant information quickly and efficiently. This week, Portsmouth city council is pioneering a new computer system, as too is Wigan. The system will be part of a national network, where solicitors, estate agents, banks and others will be able to obtain direct answers to the usual searches and inquiries. One third of Portsmouth property is now held on computer, and the aim is for complete coverage by the end of 1989. We have tolerated for far too long too many expectations of delay in what ought to be a quick and simple process.
I understand that the current ministerial response is that law reform should stay out of this area, that the remedy lies in the hands of those involved in house buying rather than in the law, and that there is nothing to stop people in England and Wales using the Scottish system if they want to. The trouble with that line is that it is far too complacent. Unless we have legislation, ordinary house buyers will never be able to bring about any significant change in the practices and customs of professionals, just as they could not tackle the scandal of the conveyancing monopoly without legislative help.
All that is lacking is the political will to legislate. I hope that my effort today, added to those of many others of all parties, will have its effect. My system is not perfect, but it would make things better. That is no more or less than most legislation can hope to achieve.
A gazumper is a swindler, a cheat and a racketeer. The present state of the law and practice allows him or her to operate without sanction of any kind and regardless of the damage caused to innocent parties. That is neither ethical nor just. It cannot be right. My Bill would provide some redress. I commend its introduction to the House.

Question put and agreed to.

Bill ordered to be brought in by Mr. David Martin, Mr. Matthew Carrington, Mr. Barry Field, Mr. Ian Gow, Mr. John Heddle, Mr. George Howarth, Mr. Richard Livsey, Mr. Ian McCartney, Mr. Keith Mans, Mr. Rhodri Morgan and Miss Ann Widdecombe.

GAZUMPING (ABOLITION)

Mr. David Martin accordingly presented a Bill to prevent gazumping in connection with buying and selling homes: And the same was read the First time; and ordered to be read a Second time upon Friday 8 July and to be printed. [Bill 189.]

OPPOSITION DAY

16TH ALLOTTED DAY

National Health Service

[Relevant documents: The First Report from the Social Services Committee, Session 1987–88, on Resourcing the National Health Service: Short term issues, HC 264-I, the Government Response to that Report, Cm. 405 and the Third Report. from the Social Services Committee, Session 1987–88, on Resourcing the National Health Service: Prospects for 1988–89, HC 547.]

Mr. Robin Cook: I beg to move,
That this House congratulates present and past staff of the National Health Service on forty years service to the public; reaffirms its support for a comprehensive health service, free at the point of use to all citizens and funded out of general taxation, and rejects proposals to end its universal character by subsidising the better off to opt out; welcomes the recent conversion of ministers to the fundamental principles of the National Health Service, and invites them to demonstrate their commitment to it by tackling the serious underfunding confirmed by the latest report of the Social Services Committee (House of Commons Paper No. 547 of Session 1987–88), in order to raise the quality of patient treatment, medical research and community care and to assure development of the best principles and practice of the National Health Service in the future.

Mr. Speaker: I have selected the amendment in the name of the Prime Minister.
No fewer than 30 Back Benchers wish to take part in the debate. I make a plea for brief speeches from the Back Benches and the Front Benches so that we may avoid the distress that was caused in the foreign affairs debate last week.

Mr. Cook: Forty years ago today, the National Health Service came into being. With its birth, there was swept away the system of charity hospitals dependent on lotteries and flag days to stay open—a system in which few went to the dentist for preventive care because they were charged even for a dental examination and a system of two-tier health care in which panel patients went round the back to the waiting room while private patients came through the front door to go into the doctor's parlour.
It was a bad health system. It was bad for the nation's health. It was bad for the dignity and self-respect of the individual who could not afford health care treatment. That is why Opposition Members will fight any attempt not to take the NHS forward but to take it back half a century to the divided health system which it replaced.
During the past 40 years, the NHS has served us well. It has provided universal cover, and, because nearly everyone uses it, there is no stigma attached to those who do. It provides comprehensive cover through a network of district general hospitals which have brought nearly every specialty into every neighbourhood in Britain. It has also sustained centres of excellence that can hold their own with the medical schools of any other country, whether it be on quality of training, or research or innovation. It has done that while also supplying a unique system of primary care barely paralleled throughout the western world in which even after nine years of this Government three quarters of all consultations take place within 24 hours of

the approach. However, most important of all, the NHS has separated the anxiety of paying the bill from the stress and pain of being ill.
I presume that those points are common ground between Members on the Front Benches, although they may be controversial according to some voices from the Back Benches. I presume that it is common ground between myself and the Secretary of State that the NHS has served us well and made those achievements because I note that, in recent weeks, the Secretary of State has been claiming credit for the Conservatives in having created the NHS.
I was somewhat surprised to be woken up the other morning by the Secretary of State informing us on the radio that it was not Bevan who formed the NHS in 1948 but Churchill in 1944. There is, of course, one inconvenient historical fact in that reconstruction of history, which is that every Conservative Member voted against the creation of the NHS on the Third Reading of the Bill.

Mr. Michael Fallon: The hon. Gentleman has just said that the NHS has served this country well. Did it serve this country well during the period of the last Labour Government when the hospital building programme was cut, nurses' wages were reduced in real terms, there was severe industrial action and waiting lists increased?

Mr. Cook: If the hon. Gentleman will wait while I go through my speech—I shall respond to his point in a moment—he will see how the present situation compares with that left by the last Labour Government. If he speaks to the nurses from the Royal College of Nursing who have been speaking to many of my hon. Friends and to members of the minority parties and asks them whether they would rather go back to the administration of the NHS in the 1970s or continue with the Government's policies, I have not the slightest doubt about the reply he will receive. If he cares to ask them about pay, they will remind him of something that he has obviously forgotten, that it was not a Conservative Government but a Labour Government who appointed the Clegg commission.
I was recalling to the House the fact that every Conservative Member available voted against the NHS on the Third Reading of the Bill. However, I accept the Secretary of State's assurances that that was just a roundabout way of expressing their support for it. What is at issue is not what they thought about the NHS in 1948, but what they think about it in 1988.
Yesterday the Secretary of State addressed the Centre for Policy Studies, and in the course of his speech he said:
We must tackle the deep-seated tendency within the NHS to self-denigration.
I am sorry, therefore, that the Secretary of State did not take the opportunity to rebut the insulting observation about the NHS in one of the recent submissions from the Centre for Policy Studies to the review. In one of its recent submissions, it wrote:
It is doubtful whether long stay prisoners in maximum security gaols fare much worse than NHS patients.
That is the kind of sentence that leaves one doubtful whether the authors have ever seen inside an NHS ward and absolutely certain that they have never visited a maximum-security gaol. It is unfair to the NHS, half of whose patients are in wards of five or fewer beds. It is even unfair—that is saying something—to the Government's


stewardship of the NHS, and it is grossly unfair to the dedicated, committed nursing staff whom most patients do not remember as gaolers.
The co-author of that sentence was the hon. Member for Wokingham (Mr. Redwood), who I am pleased to see is in his place. Until the last general election, he was head of the Prime Minister's policy unit at No. 10. There is little point in lecturing the NHS on self-denigration when working at No. 10 breeds such prejudice and contempt for the NHS and those who work in it.
That brings me to the review currently being conducted from No. 10, not from the Department of Health and Social Security. I and all my hon. Friends would welcome a review of the NHS, if it were an open review, if it were accessible to those working in the Health Service and if the submissions were being weighed by open and independent minds. We do not have that. Instead, we have review by Cabinet sub-committee. Every member of it is a Minister—the Secretary of State and the Minister of State, Department of Health and Social Security, the Chancellor of the Exchequer and the Chief Secretary, and the Prime Minister. I would not be so provocative as to suggest that there is not an open mind among them, but not one of them works in the NHS. Indeed, not one of them is known to use the NHS. This is not merely a closed review; it is a hermetically sealed review.
My colleagues and I have tabled more than 50 parliamentary questions about the review since it was formed, and we are none the wiser now than when we started. Our attempts to ascertain the remit have been met with the formula that it is wide-ranging and fundamental. Publication of the evidence has been refused on the ground that some of it may have been confidential. It is not said that it was confidential. Instead it is said that it may have been confidential. We have been refused a list of those who submitted evidence on the ground that it is impossible for Ministers to distinguish between those who formally submitted evidence and those who just popped into the post general advice which Ministers found came in handy.
I put to the Secretary of State a request that, if met, will help to persuade us that a genuine review is taking place, not an exercise in party politics.

Mr. Eric Forth: If the NHS was in the state of crisis that was regularly claimed by Labour Members and the media during the period of hysteria earlier this year, was not that an indictment of all those responsible within the Health Service for managing it, they being unable to make suggestions for reforms to improve it? To invite them to contribute to a meaningful review would be to commit a mistake which has been made before, which is to ask the producers effectively to review their own production.

Mr. Cook: I am delighted that the hon. Gentleman is in his place for the debate. We look forward to his contribution to it. Only a fortnight ago Worcester district health authority resolved permanently to close 25 beds. I have no doubt that that will be presented to us as not being an example of crisis in the NHS. I remember a succession of Health Service employees who went to Downing street and then to the Secretary of State to voice their

constructive views on the future of the Health Service. I remember also that not a blind bit of notice was taken of any of them.
The origins of the review were a constitutional novelty. It was announced by David Dimbleby on television, not in a ministerial statement in this place. But let us look forward to the conclusion of the review. Will the Secretary of State give the House an undertaking that when the sub-committee has ended its labours and has arrived at its prescription for the NHS he will do the House the courtesy of announcing that news first in Parliament and not, as it has been widely suggested, from the rostrum at the Conservative party conference? I warn the right hon. Gentleman that if he chooses the second course he will convince every health worker that the review is part of an exercise to improve the image of the Tory party and not the quality of the NHS.
There has been a remarkable and fascinating shift in ministerial comments on the NHS review over the period of the review. Initially, we were told that the review would lead to a fundamental rethink. The Secretary of State, in addressing that well-known fixture in the medical calendar, the annual dinner of the Aldershot Conservative Association, said:
The impact on the nation's health could be as dramatic as the discovery of penicillin.
He said also that he was looking at any and every idea. How did the ideas tumble out? In a succession of background briefings we heard about opting out, health stamps, vouchers and health maintenance organisations. That was in February. In the past month the Lobby briefings about everything being up for grabs have dried up. Last month, the Secretary of State told us that there will be no big bang in the NHS. The buzz phrase now is that the result of the review will be evolutionary, not revolutionary.

Mr. Jerry Hayes: Will the hon. Gentleman give way?

Mr. Cook: As I have not yet given way to any Opposition Member, I shall do the next best thing and give way to the hon. Gentleman.

Mr. Hayes: I hate to destroy a good story with the facts. However, has the hon. Gentleman read the public expenditure White Paper, which was published in January 1988, which was after the review was announced and before the various speeches of my right hon. Friend the Secretary of State for Social Services? The White Paper stated:
The Government remain committed to the principle that the NHS should be financed largely from taxation.

Mr. Cook: The "largely" started to disappear. I shall come to that.
Why has there been a retreat? The retreat is quite easy to explain. The polling data for the review have been telling the members of the review team exactly what they tell anyone else after the public have been consulted, that is, that the British public are overwhelmingly attached to the Health Service. That was admitted the other month by the Secretary of State's most junior Minister, the Under-Secretary of State for Health and Social Security, the hon. Member for Derbyshire, South (Mrs. Currie). The hon. Lady said:
We do seem to have a hang up in Britain that somehow it is wrong to pay for aspects of health care.


The hon. Lady is right: the British public do have that hang up, as she so elegantly expressed it. If I may rephrase what the hon. Lady said, the British people have a deep attachment to the principle that health care should depend on how ill someone is and not on how well off he is. They know that the health care system that best gives effect to that principle is a publicly funded system that is free at the point of use—in other words, the NHS. That is why the Secretary of State is now so anxious to assure us that he fully supports the principle of a universal comprehensive service that is free at the point of use. The Government's amendment deletes those words from the motion, but the Secretary of State keeps assuring us that he supports the meaning of those words.
If the Secretary of State means that, let us hear from him what he proposes to do in the light of his conversion to undo all the measures that he and his predecessors have taken to undermine that principle. Under a Government who are committed to the principle of health care that is free at the point of use, prescription charges have increased by 1,200 per cent. since they took office. It is cheaper now to buy over the counter many of the more common drugs. Under a Government who are committed to a free Health Service, what is happening to eye tests? They are leaving that vital preventive service to be provided at whatever price the market will bear.
There has been privatisation of services in the NHS. The Government, who are committed to a publicly funded and publicly managed Health Service, are punting out to those who measure health care against profits the ancillary services within our hospitals. The Select Committee on Social Services discovered yesterday that 40 per cent. of nurses' time is taken up in performing non-nursing duties because of the shortage of support staff. The Select Committe urged the Government to consider how it might be possible to put more domestic staff into the wards. It would not be necessary for the Government to consider that if they had not shed 70,000 domestic posts in the wards in the process of competitive tendering. Let us hear from the Secretary of State how he squares all the steps to put health care in the market place with a commitment to keeping the NHS out of the market place.
If the members of the sub-committee who are reviewing the NHS have come to the conclusion that the NHS is a fine British institution, let us hear from the Secretary of State how the review will tackle the real challenges of health care in Britain. I ask him, when he speaks, to deal with community care. It is an area of common ground between the occupants of the two Front Benches. There is common ground that the sooner we close the large crumbling institutions that hold the mentally handicapped and the psychiatric ill, the better if will be for those patients.
It is ironic that those who stay the longest in our hospitals are frequently to be found in the oldest buildings, including the old workhouses which were in place a century before the NHS was established. That is why both this Government and the last committed themselves to housing those patients in a more normal environment in the community. However, I must say that, under this Government, care in the community is becoming a cynical deceit, a slogan used to conceal a programme for shedding expenditure on the mentally ill by closing their hospitals and dumping those people on a community that has no facilities to cater for them.
Twenty-five thousand hospital beds for the mentally handicapped have gone under this Government. The appalling truth is that there is no official idea of where those patients are.

Mr. Tim Yeo: rose——

Mr. Cook: No, I shall not give way.

Mr. Yeo: Will the hon. Gentleman give way?

Mr. Speaker: Order. The hon. Member for Livingston (Mr. Cook) is not giving way.

Mr. Cook: I am grateful for your protection, Mr. Speaker. I am conscious of your instruction at the beginning of this debate. I have already given way on three occasions to Conservative Members.

Mr. Yeo: Will the hon. Gentleman give way on this point?

Mr. Cook: No. With great respect to the hon. Member for Suffolk, South (Mr. Yeo), it is open to any hon. Member to cry, "On this point" when they wish to interrupt.
We have an unofficial idea of where those mentally handicapped people have gone.

Mr. Neil Hamilton: They have gone to the Labour party.

Mr. Cook: If I may say so, I regard that as being a most insulting remark to the discharged patients of hospitals for the mentally handicapped. [HON. MEMBERS: "Withdraw".] I echo my hon. Friends' request to the hon. Member to withdraw his remark—not because we are insulted by it but because he insults the patients of the NHS.

Mr. Hamilton: I certainly withdraw my remark. They are probably too intelligent to go into the Labour party.

Mr. Cook: I only hope that the relatives of those former patients of hospitals for the mentally handicapped and the people who worked in them will be aware of that exchange and of the contempt that the hon. Member has shown for them, as a butt for his humour, rather than as people who ought to receive health care assistance.
We have an idea of where some of those patients are. They fill our lodging hostels. They can be found sleeping rough in half a dozen places within two miles of this Chamber. They are turning up in our courts. Hon. Members who saw the reports of the disturbances at Risley remand centre will have noted that staff commented that one of the problems was the increasing number of mentally handicapped people being admitted there.
Those local authorities that try to expand their social services to match the need find themselves penalised with rate penalties. Those individuals who give up work to look after a relative find themselves penalised by the latest round of social security cuts, which give no premium to carers. They are now threatened with a poll tax demand for the extra resident in their household.
The Secretary of State is well aware of those problems.

Mr. Yeo: rose——

Mr. Cook: I shall not give way to the hon. Gentleman.
The Secretary of State has seen those problems spelt out in several reports, of which the latest——

Mr. Yeo: rose——

Mr. Cook: I have clearly said that I shall not give way to the hon. Gentleman. I have already been obliged to give way on four occasions to Conservative Members.
The Secretary of State has seen the problems spelt out in several reports, the latest of which was that of Sir Roy Griffiths, who had the bad taste to point out that community care will work only if we give a much wider role and much greater resources to local authorities. That view was so unpopular in Downing street that Sir Roy's report was smuggled out with no statement being made to the House and with no press conference for the media, and it was published on the day on which Sir Roy was under an anaesthetic in an operating theatre. The Secretary of State may have buried the report, but he cannot bury the issue.
If the Secretary of State takes community care seriously, he must spell out how the Government intend to make a reality of their rhetoric about community care. I am sorry to say that, judging by the leaks trickling out, it does not look as though that is what the review will tackle, but rather that it will fit neatly with the Government's social priorities. Press reports suggest that the only help provided will not be for the poor or for those in need of health care, but will take the form of tax concessions and subsidies in respect of private medical insurance. Not many of the mentally handicapped will pick much out of that.
The Secretary of State, wearing his social security hat, is fond of advising us that an important aspect of Government policy is to target health. Tax concessions are an odd form of targeting. They target help on the wealthy, who will benefit most because of the higher taxes they pay, and on the healthy, because the private insurance companies claim the right to screen and to reject the unhealthy. I saw that principle defended last week by the managing director of WPA, which is Britain's third largest medical insurance company, on the ground that it enables essentially healthy people to avoid being penalised by unhealthy people. That statement at least has the originality of identifying the healthy as the vulnerable group, to be protected against the unreasonable costs of the unhealthy. The truth is that any sum spent on indirectly subsidising private health insurance will achieve a much larger and more immediate impact on health resources than if it is spent directly on the NHS.
That returns us to the origins of the review, because it was not undertaken because the Government are anxious to set about improving the NHS. Only a fortnight before the Secretary of State announced in a letter to me that there would not be a review of the NHS. The review was born out of panic, as the Government reeled from the publicity last winter about the underfunding crisis in our hospitals. That crisis remains.
Last week Bloomsbury district health authority approved a package of cuts that will shed another 80 beds at University College hospital. The Secretary of State will be aware that he has received an internal report from the DHSS pointing out that, in the last three years alone, London has lost acute beds equivalent to six entire district general hospitals.

Mr. Jeremy Hanley: Will the hon. Gentleman give way?

Mr. Cook: No, I shall not give way. I am anxious to make progress.
Nor have those closures taken place only in deprived areas——

Mr. Hanley: rose——

Mr. Cook: I shall not give way. I must proceed with my speech. I have been on my feet for 25 minutes and I am anxious to move to a conclusion.
Those closures have not taken place only in deprived inner city areas. Conservative Members know that they are occurring also in their constituencies. This month, Solihull has announced the closure of 37 beds, and Yarmouth proposes to close 60 beds on 17 July unless it receives a cheque in the post by then.

Mr. Hanley: rose——

Mr. Cook: You have invited us to keep our remarks as brief as possible, Mr. Speaker, and I am endeavouring to do so. Plainly it puts me in a difficult position when hon. Members unreasonably interrupt. I have already given way to four Conservative Members.
Gloucester district health authority has gone for the whole fist of closing one hospital, two maternity units and two operating theatres. Most piquant of all are the continuing financial pressures in Barnet, which contains the Finchley constituency. Last April, we were assured that one reason why the Government back-pedalled on housing benefits was that the Prime Minister was also a constituency MP, and as such had been experiencing some difficulty—as had her Back Benchers—in answering awkward letters.
Therefore, I hope that the right hon. Lady read the letter in the Hendon Times from the local obstetric consultant, pointing out that the closure of the Victoria maternity hospital in Barnet had reduced maternity services there to crisis point. He wrote:
It would be unfortunate if the Barnet public were deceived into believing that all is well with the NHS … Only a commitment to health care and a readiness to provide resources at all levels will produce a realistic remedy.
That must be the test of the review. Having quietly buried all the loopy ideas for alternative funding, the Secretary of State is left with no alibi. If there are to be adequate resources, he must supply them. Without them, he will be left presiding over the steady erosion of the NHS.

Mr. Peter Thurnham: rose——

Mr. Cook: No, I shall not give way.
I conclude with a striking example of how far that erosion has gone. Today, on the 40th anniversary of the NHS, a pensioner in Birmingham will be entering the Nuffield hospital for a hip operation donated by the magazine Retirement World as part of a promotion drive in which it is paying for an operation to a lucky reader. The company, with no hint of irony over the date, has described the operation as the country's first sponsored surgery.
I have seen too many patients in pain and frustration awaiting a hip operation not to understand the relief, even the gratitude, that that pensioner will feel now that her waiting time is over. But I find it wholly repugnant that she should depend for her operation on a company intent on a sales drive. The fact that a Minister has welcomed that operation makes a mockery of the Government's commitment to a universal Health Service free at the point of use.
I invite all hon. Members, some of whom may be hiding on the Conservative Back Benches, some of whom may well be genuine in their commitment to the principle of a free Health Service, those who share my sense of repugnance at that commercialised operation, to vote with the Opposition tonight to reaffirm those principles on which the NHS was founded and to call for the resources to make it a reality.

The Secretary of State for Social Services (Mr. John Moore): I beg to move to leave out from "House" to the end of the Question and to add instead thereof:
'warmly congratulates present and past staff of the National Health Service on forty years service to the public; recognises the achievement of Her Majesty's Government, firmly based on a strong economy, in devoting record resources to the Service to enable both hospitals and community services to provide more care than ever before; and welcomes the current review to ensure that the Service is even better in the years ahead.'
Before I start my main points, I want to illustrate to the House the bizarre nature of the last point that the hon. Member for Livingston (Mr. Cook) has just made. I have never doubted his passion and his commitment, as I have never doubted that on both sides of the House, to patient care. The hon. Gentleman did me the good fortune to use the same illustration in a speech that he made on 28 June. Therefore, it might be useful if I remind the House that, quite apart from the one decent pensioner, to whom he rightly drew attention, who is having a hip joint operation today, there are now 14,000 extra such operations per year—40 per day—compared with when Labour left office, care of the NHS. If Opposition Members are so purblind about their interest in patients that they decide not to welcome additional funds for an additional operation, they are interested only in politics, not patients.
Let me start by saying that the anniversary—[Interruption.] I have used the NHS all my life. I have also, unlike some Opposition Members, found it sensible, since I am lucky enough to have sufficient money as a consequence of the income that I now have, to supplement that health care.
All anniversaries are important, especially the 40th. The 40th anniversary is an unusual opportunity, as those who pass through it know. It is a time not only for congratulation but for reflection. I hope that the House will give a subject as important as the NHS the benefit of the quiet sensible reflection that it merits.
I start—I am sure that the hon. Member for Livingston will join me—by congratulating all the staff, not just those who are currently in the NHS, but those who have served the service for the past 40 years. They have enormous achievements to their credit: achievements that merit congratulation from all of us. Not only have enormous achievements been made, but throughout the joint stewardship of both major parties represented in the House—a stewardship that means that for 26 out of the 40 years a Conservative Government have sought, as the majority partner in that stewardship, to sustain the NHS.—[Interruption.] If interruptions from a sedentary position continue, I shall have to take a little longer, Mr. Speaker, than you would like me to and draw hon. Members' attention to the kind of press coverage that surrounded the 30th anniversary of the NHS in 1978, when

the British Medical Association could not even sign a congratulatory note. However, I shall not be trapped into doing that.
In the 40 years that we are talking about there has been a consistent commitment to the initial underlying aim that access should not be dependent on means. I find it bizarre that Opposition Members, including the hon. Member for Livingston, have the temerity constantly to attempt to rewrite history. Therefore, I thought that it might be helpful if I brought before the House again the White Paper presented to the House in February 1944. That was a White Paper of a coalition, not a Conservative, Government. It started with a basic endorsement that has been unchallenged by both major parties in the House—[Interruption.] The hon. Gentleman has obviously not studied the issue as carefully as he might.
Let me remind the House what was said on that occasion. The first paragraph of the White Paper says:
The Government have announced that they intend to establish a comprehensive health service for everybody in this country. They want to ensure that in future every man and woman and child can rely on getting all the advice and treatment and care which they may need in matters of personal health; that what they get shall be the best medical and other facilities available; that their getting these"—
[Interruption.] It is interesting to note at what point in a serious debate the sans-culottes on the Opposition Benches decide to intervene. I shall try to continue—
shall not depend on whether they can pay for them".
I shall continue by reminding people of the amendment to the motion debated in the House on 30 April 1946 in the name of Mr. Churchill and certain other hon. Members. It started by saying—[Interruption.] It is extraordinary how, as soon as one starts to remind people of the truth, the Opposition simply are not interested. It started by saying:
That this House, while wishing to establish a comprehensive health service"—
what was debated at the time was not the basic aim: that has never been in doubt and is not in doubt—
with access to it free of the ability to pay
that is not in doubt and will not be in doubt while the Government remain in office.
However, the degree to which we can effectively deliver that goal should always be constantly under examination, whatever party is in office.

Dr. John Reid: Will the Minister give way?

Mr. Moore: No, I wish to carry on for a short while.

Mr. David Winnick: Will the right hon. Gentleman give way?

Madam Deputy Speaker (Miss Betty Boothroyd): Order. The Secretary of State has said that he does not wish to give way at this stage.

Mr. Moore: Before I look at the position today and try to relate the relative records of the Opposition and the Government, I want briefly to review one or two aspects of the past 40 years as it is the 40th anniversary.
I accept, and we all should., that since 1948 there have been major and phenomenal achievements in the health of our country and in what the NHS can offer. Since 1948 there have been extraordinary changes in the kind of diseases that then dominated debates in the House. TB, diptheria and polio, all key issues at the time, have now been virtually wiped out. It is extraordinary to think that in 1948 alone, when the Health Service began, there were


48,000 deaths from TB and only 145 deaths last year. In those years, there were about 18,000 cases of polio a year. Happily, last year there were only three or four cases.
The change in the character of the procedures that the NHS can undertake have been equally radical. In 1948 there were no hip or knee replacements, no coronary artery bypasses and no heart or heart-lung transplants. Yet as recently as 1986, the latest full year for which we have figures, there were 44,000 hip replacements, 12,000 coronary artery bypasses, 243 heart transplants and 72 heart-lung transplants. That illustrates the extraordinary nature of the change that has occurred in the NHS.

Dr. Reid: I am grateful to the Minister for giving way. In his historic summary he explained to the nation why, at a time of war and a coalition Government, the Conservatives were supporting a National Health Service. Since it is the anniversary of 1948, a year when there were 48,000 deaths from diptheria and 18,000 cases of polio, will he explain why the Conservative party voted against the legislation to establish the National Health Service?

Mr. Moore: As I have said already, the Conservative party agreed entirely with a comprehensive National Health Service. It tabled a reasoned amendment that disagreed with two features of the then proposal, one of which was utterly changed before 1948—the method of paying salaries to GPs. Opposition Members do not seem to have very much knowledge of their own party's history, let alone that of the Government. There have been an enormous number of changes not only in the character of operations, but in number of patients treated.
The second feature was the way in which it was proposed that the charity and local authority hospitals were to be taken over by the then National Health Service. It was the means that were in debate, not the aim, the thrust or the concept of the National Health Service.

Mr. Winnick: Will the Secretary of State give way?

Mr. Moore: No.
In 1948, 2·8 million patients were treated by the National Health Service. By 1986, that number had increased massively and 6·5 million patients were treated in our hospitals—an astonishing change in 40 years.
As Opposition Members do not appreciate my point, I should stress that I am not claiming that that is a record of this Government or only of previous successive Tory Governments. It is a record of both sides of the House when in office during a 40-year period. I shall illustrate that with some examples of the most significant changes that have occurred in the Health Service under the joint stewardship of the past 40 years.
Which party began the largest ever NHS hospital-building programme in the 1960s? It was not the Labour party. In 1962 the Conservative Government initiated the huge hospital-building programme. Equally, touching on a point made by the hon. Member for Livingston, which party started the critical move away from long-stay institutions to community care? Again, it was not the Labour party; it was the Conservative party in 1961 under the then Minister of Health Mr. Enoch Powell. Which party gave the biggest-ever boost to private hospitals in this country? It was not the Conservative party; it was the Labour party, with its vendetta against NHS pay beds in

the 1970s. [HON. MEMBERS: "Nonsense".] I hear suggestions of nonsense from the Opposition. Hon. Members should listen to the answer.
In The Health Service Journal of 30 June, the adviser to three Secretaries of State for Health and Social Security, Professor Brian Abel-Smith, said:
The actual effect was to stimulate the largest growth of private hospitals since the NHS began.
That was a triumph for the Labour party. Which party introduced charges into the NHS? Again, it was not the Conservative party; it was the Labour party in 1951 facing its then spending crisis. As Opposition Members know, the Labour Government did not want to introduce such charges. They did so in the face of their economic crisis, as they did in 1976. That reminds me of the crucial point that brings our debates up to date.

Mrs. Margaret Ewing: Although I am reticent to involve myself in a dispute between the two major parties, will the Secretary of State tell us of the Government's commitment to the Griffiths report, which is an agenda for action, which has widespread support? Or is there to be a continuation of the development of private nursing homes for the elderly, without adequate training or assessment of the people employed in those homes?

Mr. Moore: I am grateful to the hon. Lady for raising the same point as the hon. Member for Livingston. We shall discuss that matter another time.
I stress that I found quite distasteful one point which was raised by the hon. Member for Livingston. I would not normally regard his comments in that light, but when Sir Roy Griffiths unfortunately was taken ill I was under enormous pressure, quite properly, from the House and from outside, to publish the Griffiths report as soon as possible. I thought it proper to do so, although Sir Roy was not able to present the initial publication, because I wanted a period of consultation. We shall be considering the report because, as the hon. Lady rightly said, it is extremely important and we shall bring forward our advice when we are ready to do so.
My crucial point is illustrated quite classically by the problems the Labour party faced when in office when it discovered that one cannot fund good causes such as the NHS from tea and sympathy; one cannot fund the NHS on rhetoric. It needs resources. If there is anything that has amazed me about the recent debates, and if there is anything that I find extraordinary, it is the sheer temerity of the Opposition in trying to re-write history in regard to the resources of the National Health Service. I simply cannot believe the nature of this debate. The Labour party's record was one of its more appalling records on any single issue. I accept entirely that the Labour party would not have liked to have been as incompetent as it was when in office and did not wish to make such a radical reduction in the resources which it was able to supply. It is extraordinary that Opposition Members can associate themselves with an issue, when in office they chose to reduce the percentage of GDP they committed to the NHS from 5 per cent. to 4·7 per cent.
Contrast that with our own record. As a consequence of our extraordinary economic success, we have been able massively and rightly to increase the resources to the NHS. These are not things that the Opposition like to hear, but we have been able to increase the resources by 39 per cent. in real terms. More than that, unlike the Labour party which chose to reduce the percentage of expenditure as a


percentage of GDP, we have taken it back from 4·7 per cent. to 5·4 per cent. Many may argue that the NHS needs more resources, but the contrast in the two records is unbelievable, and the temerity of the Opposition is extraordinary. Not only have we been able to increase massively the resources, but we have initiated other major changes of great significance in the past decade.

Mr. Hanley: For a major part of his speech the hon. Member for Livingston (Mr. Cook) concentrated on the number of beds lost. He has a strange preoccupation with beds. What about the patients for a change? Will my right hon. Friend tell the House that we have increased the number of patients treated, both in-patients and out-patients—and that is more important than the number of beds.

Mr. Moore: My hon. Friend is exactly right. I did not wish to delay the House unnecessarily, but I happen to have the figures to hand. It is very interesting, as the political period from 1966 to 1986 covers both parties in office. During that time the beds available declined from 434,000 to 316,000. During the same time the number of in-patients treated rose from 4·5 million to 6·5 million. That clearly demonstrates the point that my hon. Friend the Member for Richmond and Barnes (Mr. Hanley) rightly sought to make.

Mr. Dennis Skinner: rose——

Mr. William O'Brien: rose——

Mr. Moore: I was trying to illustrate the fact that enormous additional resources have been put into the NHS, which have allowed us to look after more patients.
There have been many other important changes in the past nine years. Since 1984 we have introduced a much more dynamic management style with a general management system that is recognised and appreciated on both sides of the House. We have introduced an information revolution with Koerner reforms and performance indicators. That has been a spur to much greater efficiency. The cost improvement programme is showing significant additional moneys going into the NHS. Since 1984–85 and by the end of this year we shall have put about £750 million in cash into the NHS. Competitive tendering has sharpened up management and staff and has saved £106 million, which has been used for patient care.
Perhaps the biggest and most welcome of the recent changes are those affecting nurses. The Labour party and others have talked a great deal about nurses. In comparison with the Labour party's cut in real terms in nurses' pay we first created a review body to reflect their professional status and commitment. Secondly—hon. Members on both sides have welcomed this—with the implementation of this year's pay award and its funding we have added over 15 per cent. to the pay bill this year and improved nurses' pay in real terms by 43 per cent. since 1979. We have now put nurses' pay at its highest level ever in real and cash terms. Because of our economic success we have been able to do other things. We have backed management and staff in the introduction of a radical new grading structure to reward extra skills and responsibilities and to help keep staff at the bedside. We have agreed in principle to something that has been

dreamed of and debated in the Health Service for generations. We have agreed in principle to the educational reforms in nursing—Project 2000.
Since 1979 all those changes in management, information and nursing have not been easy. We have not shirked them. We have laid the foundations for the future but, as the hon. Member for Livingston said, there is still a lot to do. I have looked briefly at some of the history and at the current position.

Mr. Tim Smith: Is my right hon. Friend aware that the National Audit Office reported recently that £300 million could be saved by the more efficient use of land and buildings, enough to employ an extra 30,000 nurses? Does that not illustrate the scope that is still available for value for money savings in the NHS?

Mr. Moore: I was about to come to those points but m y hon. Friend is absolutely right. There is scope for improvement.
The hon. Member for Livingston asked about the future. Further measures will be taken and they will be linked to the outcome of the present review. Unlike the hon. Member for Livingston, I have been interested in what the Financial Times today referred to as the "flood" of papers that have come forward. They are not papers from the think tanks that the hon. Gentleman seems to decry but from all parts of the Health Service. There are papers that have been published and papers that are being seen and debated. There are papers from the Institute of Health Services Management, papers from the National Association of Health Authorities and papers from the King's Fund which will be published this week. They all argue rationally, although with different views, for the need to concentrate on change to improve the system.
I have read with care the hon. Member for Livingston's speech of 28 June. On page 21 I was interested to see that we shall not have the benefit of the Labour party's internal review, which I understand will be published in the autumn. It is an internal review that he suggests will coincide with the Government's. I hope that we shall see that review when it is published, unlike the review on social security, which has never seen the light of day.
The Labour party has made it clear that the one thing it wishes to see for the NHS is more cash. We are back to the same old oft-repeated cry. I genuinely like the hon. Member for Livingston and I can only hope, for my party's prospects in office, that his right hon. Friend the Leader of the Labour party will give as much credence to his views on health as he has to his views on defence. It will be a great help to my party.
On the matter of the Government's review, no decisions have yet been taken. The hon. Member for Livingston knows that. However, the outlines of some of the areas of major interest——

Dr. Lewis Moonie: Will the right hon. Gentleman give way?

Mr. Moore: I have already given way on more than enough occasions.

Mr. Skinner: rose——

Mr. Moore: The outlines of the major areas of public interest are becoming clear. The first area, on which I would expect there to be common ground across the Floor of the House, is that we all recognise that we must


strengthen consumer power and choice. That will require much more information about the services and offers and, for example, about the choice of doctors.—[interruption.] I can take as much time as the House would like. I would like to continue if possible. There are people outside the House who are interested in this subject and understand, as do one or two Opposition Members, including the hon. Member for Livingston, the seriousness and importance of the debate.
As opposed to the Government's clear view about the need to improve the role of consumers, I was delighted to see that the present deputy leader of the Labour party, as was shown in Glasgow this morning according to the tapes, is following similar lines in his arguments about user-friendly blueprints. It is an area in which we shall be arguing on similar lines. We both want to see much greater emphasis on the quality of care in both the personal and medical sense. We have to pursue the growth of peer review and clinical audit.
We have to look at ways in which we can involve the doctors much more fully in the management process. Alongside their clinical freedom, they must be able to participate in the overall decisions about priority resources.—[Interruption.] The hon. Member for Livingston is nodding because he had the patience to listen to the end of my sentence as well as the beginning. That is obviously difficult for other Opposition Members.
The hon. Member for Livingston and others will be as interested in and as committed to the serious experiments at places such as Guy's hospital in the resource management initiative. We are seeing great improvements in patient care as a consequence of greater involvement in resource management by the doctors.
There may not be such a close agreement about our belief that we need to break down the barriers between private and public provision. There are many examples of that. The National Health Service contracts could be with private hospitals and vice versa. We have to use much more private capital to help fund joint facilities of the bioplan examples. In my diligent reading of the hon. Member for Livingston's speech I was fascinated to see on page 8 that he finds quite acceptable the suggestions of the Institute of Health Services Management about charging for a la carte as opposed to table d'hote. However, he did make other references to that.
Another area in which we are on reasonably common ground, although the semantics of the debate have become difficult, is the belief that we need to create a better mechanism to recognise the efficient and stimulate the inefficient. As the Select Committee on Social Services rightly said, we have a perverse system where the most efficient and the best hospitals in many ways are in difficulty over resources as a consequence. Many words are used to describe that. The quaint phrase used in the Health Service is "cross-boundary flows". The hon. Member for Livingston's speech contained serious references to that.
There are many areas beyond those I have mentioned where, from the review, I expect to see rational and sensible progress made. The 1944 White Paper laid the foundations for the NHS. It said:
Reform in this field is not a matter of making good what is bad, but of making better what is good already".
That was the vision that fired the then Conservative Minister responsible for health, who happened to

represent part of Croydon. It is the same vision that fires the Government today. But we must not confuse ends with means. We must stay true to the fundamental principle of the Health Service while equipping it for the fundamental challenges of the next century. That principle—this is a very critical point—is that access to good quality health care should be determined by medical need and not by ability to pay. This was of crucial significance at the creation of the NHS and I believe that it should and will remain the key to its future. But an institution that fails to adapt to new situations and new demands will never satisfy the hopes placed in it.
We must never forget that it is those on the Opposition Benches who pose the greatest threat to our Health Service. They are a threat because they could not produce the resources; they are a threat because they would not keep faith with the staff; and they are a threat because they would always duck the decisions necessary to ensure that the next 40 years of the NHS are as successful as the first 40 years. They may want to shirk their duty to the people of this country. We shall not. We shall face up to our responsibilities and in doing so enable the Health Service and all who work in it to look to the future with confidence.

Mr. Michael Foot: I am glad to have the opportunity to speak immediately after the Minister as I believe that I am the only Member who was here when the 1946 debate took place and the 1948 measure was carried into effect.
But before I come to the speech of the right hon. Gentleman—and I certainly want to deal with many of the matters that he has raised—I must congratulate my hon. Friend the Member for Livingston (Mr. Cook) and, indeed, the leader of my party, my right hon. Friend the Member for Islwyn (Mr. Kinnock), because it is they principally, with backing from the whole Labour movement, who have kept the National Health Service at the front of the political debate in this country over many months and years.
During the general election, my right hon. Friend the Member for Islwyn time and again returned to this theme. If he had been heeded then, and if the Government had been prepared to act on the appeals that he and my hon. Friend the Member for Livingston were making, we could have had the kind of debate that the Minister said that we should have. If the Government had provided the £2 billion extra money for the Health Service, I believe that the debate would have been much more profitable and useful, because the immediate strain could have been relieved. At some stage, if the Government are to do their duty, they will have to provide that kind of increase to the present funding of the NHS. That will be conceding what the Labour leadership and the Labour party have been demanding throughout.

Mr. Edward Leigh: Will the right hon. Gentleman give way?

Mr. Foot: I have been on my feet for only a minute or two. I would prefer to get on.
I come now to the Secretary of State. I listened to his speech on the radio the other day about the origins of the National Health Service and I listened even more carefully to him today. He must find some difficulty in pronouncing


the name "Aneurin Bevan". Perhaps he has some speech impediment, as Aneurin Bevan himself had, because he finds very great difficulty, when talking about the founding of the NHS, in ever mentioning Aneurin Bevan's name. That seems to me to be a most ungracious way for the right hon. Gentleman to talk, particularly when he gives such a misleading record of what happened.
I was in the House when the Bill was introduced and carried through by Aneurin Bevan in the teeth of opposition from the Conservative party. The Tories voted against the Bill not only on Second Reading—the right hon. Gentleman quoted a part of the motion, but I could quote it all because I have it here—but on Third Reading,which, in those days at least, was a strange thing for a party to do unless it was bitterly and absolutely opposed to the principle of a measure. Then the Conservatives were given a third opportunity by Aneurin Bevan, a few weeks before the introduction of the NHS—when the British Medical Association said that it would not co-operate—to say whether they would give some support to the introduction of the service.
In the face of all that, the Secretary of State should not waste time rewriting history. He should devote himself more to the things for which he has such a gift—presenting us with his half-cooked theories and his cooked figures. He is much better at that than at rewriting history.
When I was writing about these matters I interviewed all the leaders of the profession who had negotiated with Aneurin Bevan at the time of the introduction of the scheme. Not one failed to acknowledge the unique part that Aneurin Bevan played in shaping the service and bringing it into operation. I suggest that the Government should listen to what they had to say. So concerned was I that the credit, honour and glory for having introduced the National Health Service should not be taken away from Aneurin Bevan and the Labour party, which carried it through, that I wrote many years ago that it was possible that somebody would come forward and rewrite history, and that the archives would be ransacked to produce the forgotten name of Sir Henry Willink to mesmerise the House on such an occasion as this. Now we are told that he was the great author of the Health Service.
I prophesied this earlier and perhaps I may be permitted to quote myself. I said:
Future generations may learn that Aneurin Bevan did not make the National Health Service; he inherited it from that much underrated social visionary Sir Henry Willink. After all, did not Jesuit scholars in the nineteenth century teach children in their schools that Napoleon was a general employed by Louis XVII?
The right hon. Gentleman is even more successful in his attempts to erase the name of Aneurin Bevan from the history books, like some Stalinite censor trying to erase the name of Trotsky.

Mr. Moore: I do not know if I can be of any help at all to the right hon. Gentleman. I respect history. The right hon. Gentleman is quite right; I have sought throughout the past year and in this debate to acknowledge both sides of the issue. I would not for one moment deny the very critical, key role of Nye Bevan in 1946. I left a lot of other names out. I was trying—I know that the right hon. Gentleman will recognise this—to differentiate between the concept of a comprehensive national health service, free at the point of delivery to those who cannot afford to

pay, which I ask him to admit was acknowledged by the Opposition at the time, and the method of delivering that dream.

Mr. Foot: The right hon. Gentleman must be congratulated. I have extracted the name of Aneurin Bevan from him. It seemed to me to be quite a fierce and surgical operation. It is a pity that, having got the name out, he should have spoilt it by referring to what happened in the Churchill Cabinet. I have read quite a lot about these matters too and I can assure the right hon. Gentleman that Churchill had very little interest in the National Health Service. The right hon. Gentleman implied on the radio the other day that everything was decided by Churchill. Perhaps in some Cabinets things do operate like that; perhaps the right hon. Gentleman thought that it must have come from the Prime Minister because that is where these things come from now. That is why we have some qualifications about the committee that he talked about. I am told that the right hon. Gentleman is a member, although I am not quite sure what his qualifications are.
I should be quite happy to quote the amendments which Sir Winston Churchill, leading his party—not all its members willingly—put down against the introduction of the National Health Service. That distortion cannot be permitted. On both Second and Third Reading an amendment was put down saying that the Conservatives would like a national health service but did not want it introduced at that time and would vote against it. If their votes had been effective, we should not be celebrating the introduction of the National Health Service this year. It would not have been introduced in 1948: the whole proposition would have been wrecked. Indeed. many people in the medical profession at the time thought that it should be wrecked. They were prophesying until two or three days before its introduction that it would be wrecked.
Those views were shared by a considerable number of Conservative Members, with Sir Winston Churchill backing them, because Churchill was more interested in wrecking and ruining the career of Aneurin Bevan than in the introduction of the National Health Service. I am sorry to say that attempts by a section of the medical profession to wreck the introduction of the measure were backed by all the raucous Conservative Members. I can remember that, and nobody can contest it because I am the only one who remains.
Now that the Secretary of State can pronounce the name of Aneurin Bevan, perhaps he will be able to learn a little more from him. I wonder that he dares to talk to us about what has happened to the nurses. One of the first things that Aneurin Bevan did—even before he decided on the framework for the Health Service—was to introduce a charter for the nurses. It did not go all that far. It was primitive compared with the legitimate demands of the nurses and the nursing profession today. A matter of months before he had decided on a framework for the National Health Service he had concluded that we needed a much better deal for the nurses. He talked to the nurses and the charter was the product of those discussions.
The Secretary of State talked about his dealings with the nurses and about the acceptance of the RCN's Project 2000. I am glad that he intends to accept it. He must


provide all the money for that and for the comparable improvements that need to be made throughout the nursing profession if the job is to be done properly.
If the right hon. Gentleman thinks that the last wage settlement has dealt with all the nurses' problems, he is making a big mistake. I have talked to nurses in my constituency and around Wales, and plenty of them come here in deputations and on lobbies. Morale among the nurses is still very low indeed and much more needs to be done to put it right. If the Secretary of State wants an illustration of what needs to be done, he should read the document that he was applauding only a few minutes ago. It reveals what has really happened in the Health Service, which has so far been concealed by some of the phoney figures that his master, or his mistress, the Prime Minister, flaunts before the House. Many of those figures deserve to be subjected to fierce scrutiny.
The right hon. Gentleman talks about what the last Labour Government did but says nothing about the Halsbury report, which was much the biggest inquiry into the nurses' profession and their wages. The findings of that report were put into effect and backdated by that Government. When it was discovered that the value of the high awards recommended in the Halsbury report was being lost because of the huge inflation, we had to do something about it. The Clegg commission and other arrangements were put in place to ensure that nurses' salaries were increased. They were not increased enough, but they were increased. The present Government try to claim credit.
If the Secretary of State wants a few facts from the nurses——

Mr. Ray Whitney: Will the right hon. Gentleman give way?

Mr. Foot: No. I am dealing with the Secretary of State.
The Secretary of State referred to Project 2000. I hope that he will listen to the words at the end of the briefing which provide the answer to what is happening to nursing training. When nurses come to see me, they often refer to their training. They used to be encouraged to take part in study circles and courses to keep up with their profession. That was a fine aspiration in the National Health Service. Over the past few years, the pressures and the absence of money have prevented nurses from embarking on those study courses as they did in the past. Until the Secretary of State restores such facilities in the Health Service, he had better not boast about what the Government have done.
The contents of a reply given by the Minister for Health about nursing training appear in the nurses' report, which says:
spending on nursing education has gone down in real terms by 18 per cent. since 1979. And over 4 per cent. of nurse teaching posts are now vacant for three months or longer, but no further information is said to be available. Numbers entering nurse training dropped from 33,370 in 1979 to 22,825 in 1987.
Those figures are part of the record of which the Secretary of State boasted. Those are the figures that we rarely hear from the Prime Minister when she parades her statistics at Question Time.
The Secretary of State could take another lesson from Aneurin Bevan—the lesson of talking to those who do the main jobs throughout the service. The right hon.

Gentleman ought to be doing that instead of conducting a phoney inquiry from No. 10 Downing street. If he really has the National Health Service at heart, he ought also to talk to some of the people at the top—the presidents of the royal colleges. That is what Aneurin Bevan did. One reason why the Health Service introduced by Aneurin Bevan and the Labour Government was so different from the one that Sir Henry Willink or Sir Winston Churchill favoured was that it introduced the idea of engaging consultants all over the country.
Before 1945, most of the consultants were congregated in the great teaching hospitals in London. The idea of people throughout the country having access to consultants did not exist before 1945. How was it put into effect? If the Secretary of State wants to know the facts, they are all recorded, not only in my books but in the reports of Lord Moran who was the president of the Royal College of Physicians. He carried out some of the main negotiations with Aneurin Bevan. They asked, "How will we spread the consultants throughout the country so that people in Wales and Scotland have access to them, rather than just a few in London?"
They decided that that could be done only by having a nationalised service and by taking all the hospitals into that one service. Lord Moran described how that happened. The Secretary of State does not seem to know anything about that aspect of the National Health Service, which is one of its most important aspects. It is partly because he knows so little about it that he was apparently prepared to offend and insult the presidents of the royal colleges a few months ago. The presidents of the royal colleges wanted to put their case—[Interruption.] The hon. Member for Wycombe (Mr. Whitney) should learn to keep quiet occasionally; it is all part of the way of this House. The Secretary of State should have the courtesy and intelligence to renew those conversations with the presidents of the royal colleges. That is the second thing that the Government should be doing.
There is a third way in which the Secretary of State can learn from what Aneurin Bevan had to say. Aneurin Bevan had to fight the Treasury to get a National Health Service. It was not easy and there were many objections from the Treasury, just as there are now. Aneurin Bevan went to the Treasury and argued his case. He put his case to the House. No one ever believed more strongly in the supremacy of the House. If the Secretary of State had had the intelligence to listen eight and 12 months ago when the case was being put by my right hon. and hon. Friends the Government could have avoided some of the problems.
Ministers should ask Health Service managers how they have been treated by the Government in terms of money. The Government failed to make good the full wage awards one year and said that the money would be taken out of the rest of the finances of the Health Service. They then said that they would not perform that filthy trick next year, but they have not made good the amounts that they took from the Health Service. The Government's refusal to fund wage awards fully has gone on year after year in many parts of the country and is one of the main reasons for the cut in the amounts available for work in the NHS. The Secretary of State should listen to what other people say.
My hon. Friend the Member for Livingston has exposed the shoddy nature of the so-called inquiry. Why should we believe that a secret Cabinet committee presided over by the Prime Minister is the way to deal with these matters? The right hon. Lady will produce an avalanche of


statistics, although we have heard most before, in an attempt to suggest that everything is fine, whereas people can see that it is not. That is all that the Prime Minister is capable of doing. She does not have the imagination, or perhaps the courage, to say to the House that she was wrong in denying the Health Service that £2 billion. I do not believe that there is a Minister among those selected to be on the Cabinet committee who has the nerve to stand up to the right hon. Lady.
Why should the House have any faith in such a committee? All the worst Government errors, many of which have had grievous consequences for our people, have been the result of such committees presided over by the Prime Minister. They are remote from any critical attitude that may prevail—it may be optimistic to think that it does prevail—in a full Cabinet discussion. The most recent example, which has appalling consequences for this country's honour, is the way in which tens of thousands of the poorest people are being persecuted through cuts in housing benefits and alterations in their social security benefits. Many of the poorest people have had their lives shattered. They are persecuted because of the Government's pursuit of small amounts of money—this from a Government who, a few months before, gave away billions of pounds to the richest people. I have no doubt that that was all done through a committee presided over by the Prime Minister.
The famous Westland case perhaps involved a one-man, or one-woman, committee, but perhaps we should not inquire too closely lest it implicate others. As for the Falklands, no Cabinet committee ever discussed the evidence that Lord Carrington from the Foreign Office wished to present to the Cabinet. Everything was done by committees presided over by the Prime Minister.
In the light of experience over many years and the deductions that can be drawn from the way in which the Minister looks on the Health Service, no one can have any confidence in the outcome of the new committee. Perhaps the committee will send the Secretary of State along to repeat today's speech. We want the £2 billion to be presented to the Health Service so that it can deal with the immediate problems. Then we should restore the NHS with all the imagination and courage that Aneurin Bevan showed 40 years ago.

Mr. Timothy Raison: Part of the House has enjoyed listening to the right hon. Member for Blaenau Gwent (Mr. Foot). As Aneurin Bevan's biographer, the right hon. Gentleman is entitled to say certain things about the past, but when he diagnoses the present and future his arguments become thinner. We must think about what will happen next.
It was particularly odd that the right hon. Gentleman inveighed against the fact that a Cabinet committee would discuss this matter. He implied that there should be a great royal commission and massive amounts of evidence published. My recollection of history, which may be less good than the right hon. Gentleman's, is that when the Labour Government came to power in 1945 they did not set up a royal commission into the proposed structure of the Health Service. They got on with the job of Government, made up their mind, came forward with their proposals. put them to Parliament and, as it happened, carried them, and ever since we have had the Health

Service. I see nothing wrong in the Government's approach. My right hon. Friend the Secretary of State will listen to those who make representations. Today's debate gives Parliament a chance to chip in its pennyworth, and I hope that that is how it will be seen.
My right hon. Friend the Secretary of State was right to table an amendment making it clear that we congratulate the staff of the NHS on their 40 years of work. It has always been a difficult job. It is easy for morale to slip. Whatever our complaints about the Health Service, overall there has been a notable record of achievement. As my right hon. Friend made clear, that achievement has taken place largely under Conservative Governments. It is important to remember that we cannot have a good Health Service unless the morale of those who work in it is high, just as there cannot be a good Army regiment unless the soldiers' morale is high. We should not do anything to undermine the morale of the staff, although we must talk about some of the problems and weaknesses in the NHS.

Mr. Julian Amery: The Labour Government did not have to appoint a royal commission. A perfectly good White Paper had been produced by Conservative Health Ministers in the coalition Government, and the Labour Government built their plan on it.

Mr. Raison: That is true. There were, however, substantial differences from the Conservative approach, which favoured a closer link with local government and the retention of the voluntary hospitals.
One aspect of the structure adopted by Aneurin Bevan that I would question was the decision to make the whole hospital service have a uniform pattern. That may have seemed right at the time, but there are good arguments for saying that we have inherited a system that is too inflexible.
The Government's amendment refers to the review and the need to think hard about what is going on. Few objective observers would deny the importance of doing that. Obviously, we are not looking for change for change's sake. There is no point in making changes unless one is pretty sure that they will result in an improvement. I suspect that, because my right hon. Friend the Secretary of State has thought about these matters, that message has occurred to him often. We must come to grips with the fundamental issue of funding and the weaknesses of the NHS. To what extent are the weaknesses a result of funding and to what extent do they relate to some other factor?
There is no need to stress what has been familiar from the early days of the Health Service—that the open-ended nature of the demand and high costs of new medical developments impose enormous burdens on the Health Service. Whatever system of funding we choose, we cannot get away from that fact. The system will always be expensive and, to a great extent, the argument is based on whether it is better to produce the necessary money from taxation or constantly to seek new forms of revenue.
We must accept that more money must be spent. The Select Committee on Social Services went into this matter and came up with views, although I do not know whether they are exactly right.
Although there has been a substantial improvement, I do not think that the present level of spending will last for all time. To be realistic, before long we shall have to think


again about whether there must be an additional injection. The Treasury may not like that, but it will be hard to escape, given the background facts to which I have referred.
The funding problem is only a part of what we must face. There are other weaknesses, too. One is that the structure of the Health Service, in essence, was too monopolistic. That has proved a real weakness. In some ways the service has been too provider-oriented; I apply that to consultants at the higher end of the pile and porters and others at the lower end. For a long time the service was too much in the grip of those who were providing it. As I have stressed, they did many good things, but we must think hard about this aspect. What seems to come across from people who go to hospital—my constituents and friends, for instance—is that too often there is muddle at the point at which one comes into contact with the service, either in the ward or in the way in which a person is received into casualty or hospital reception. It is distressing to hear about people having to sit, apparently forgotten, in waiting rooms. Although much of what happens in hospital is splendid, too often one gets the impression that everything is such a rush that no one knows what is going on. That must be tackled. Fundamentally, it is not a matter of resources.
Of course, it is more difficult now. A greatly increased throughput of patients means that the management of a ward is much more difficult than it was in the days when patients were in for a long time and the process was more leisurely. The administration of drugs is another complication. So there are reasons for the apparently hectic climate, but those who run the service must get to grips with the problem. It is causing much disappointment—or worse.
Patients have responsibilities, too. It is distressing to read of the number of occasions when they fail to turn up for appointments. There was a long fight to achieve appointment services, and rightly so. But the statistics are appalling. I have been worried by a case of which I have heard. In the drive to cut waiting lists, and with the additional money that the Government have provided for that purpose, it has proved remarkably difficult to reduce their length because patients who are allegedly part of the lists somehow vanish into thin air. They do not seem to exist, even though the additional facilities are provided, and I can give chapter and verse on that if necessary.
What should we be doing about the present system in a more fundamental sense? The introduction of general managers has been for the good. The fashon for something called consensus management of a decade or so ago was a disaster. It is not the way to manage any organisation. At the national level, there is not much mileage in the arguments for an independent corporation which are often put forward—the attempt to find a Health Service management board that will operate like an industrial board. That will get nowhere for the simple reason that we in this Chamber do not want it. We shall not allow the job of management to be handed over to a management board in such a way that we cannot take up our constituency cases. We shall insist on defending our cottage hospitals, and so on. We shall insist that my right hon. Friend and his Ministers answer all our questions in debates like this,

in Adjournment debates and so on. As long as that is so, it is pie in the sky to believe that we can have the sort of true management that is to be found in industry.
I do not believe that the insurance-based approach will provide the solution, either. It has been discussed for years; it has always been the favoured alternative. It is the alternative that other countries have adopted, and some of them are not doing badly with it, but there are certain substantial problems. One is that insurance inately tends to put up costs. Patient and consultant, knowing that they are part of an insurance scheme, have no incentive to keep costs down. There will, therefore, be upward pressure that will be difficult to control.
Then, as we all know, there is a peculiar problem with insurance. It is that a high proportion of the patients of the Health Service are old people who are almost certainly less well off. There is also the psychiatric and chronic cases—exactly the sort of cases from which the insurance companies shy away as fast as they can. Perhaps they will do a little more to try to support such cases. Perhaps it will be possible in the medical insurance schemes to pay more when young for more benefit when old—but that will not really provide the answers that we want.
At the same time, I do not support the idea that we should give tax rebates to those who opt for private insurance. Whether that would be beneficial from the Treasury's angle is a matter of argument. Some of my hon. Friends have argued that it would, but others will say that the loss of revenue will outweigh anything that is likely to be gained by more people moving into the private sector——

Mr. Forth: Has my right hon. Friend considered a compromise that is an immediate possibility? Tax relief could be offered in the first place to those of retirement age only, on the basis that not only would that provide a specific target group on which the effect could be assessed, and limit the cost to the Treasury, but, importantly, it would offset the increased cost of health care and insurance for that age group, thereby providing an important balancing factor.

Mr. Raison: I have thought about that. My hon. Friend is right to raise the point. We are faced with the fact that some old people who are insured with the assistance of tax relief will still suffer incurable long-term illness, for which insurance will not provide the answer. The risks of some form of psychiatric illness will still be present, too. So although I see my hon. Friend's point, I do not think it gives the necessary certainty.
Other ideas have been canvassed. One is to convert the national insurance scheme into a national health insurance scheme and transfer pensions and so on to the tax system. That is worth considering, but it does not contain the answers that we seek. It may create greater transparency for health, but the problem will be transferred directly to the pension system, and I am not sure that people will benefit from that.
Although I may seem to have been negative so far, the one area in which I believe there is real scope for significant change is that first opened up by Professor Enthoven, which is generally called the internal market approach. Enthoven is much the best of all who have studied and written on these problems. I only wish that he was based in the United Kingdom and not the United States. I shall not go into the internal market arguments, as my right


hon. Friend the Secretary of State knows them well, but they offer the chance of the sort of choice, variety and a little competition that has been lacking in the monolithic structure of the Health Service until now—but they do so in a way that does not land us with the fundamental difficulties that lie in the adoption of insurance as the overall answer.

Mr. Whitney: Does my right hon. Friend agree that Enthoven made his proposals on the assumption that there was not the political courage in this country to effect significant changes in the structure, so the proposals that he made were within a tight parameter?

Mr. Raison: There is something in that, but one of Enthoven's merits is that he approached the Health Service in a sympathetic way. He did not say that the whole thing was a shambles and we should tear it apart. He made a good judgment of the realities and feelings of the service, for which I respect him. So I align myself with him. The only other thing inherent in what he has to say is that we should think about whether it is possible to do more to separate the management of the hospitals from the general strategic provision of the service.
I am not particularly persuaded by the health maintenance unit arguments in full, but I think that we might be better off if the health authorities were concerned with co-ordination, planning and ensuring that the provision is there, but the management of hospitals was separated. Perhaps we could see again the existence of voluntary hospitals, private hospitals—as we know them—and National Health hospitals as well. We need more diversification, and a greater spread of accountability and responsibility.
It is a difficult job, but an extremely important one. We will get nowhere if we start from the premise of deciding to tear the whole thing apart: the service is far too important for that. If, on the other hand, we simply say that things are fine, we shall have failed our constituents. I believe that, when the Government come up with their answers, they will be able to put forward proposals that make sense and breathe new life into this distinguished service.

Dr. David Owen: The right hon. Member for Blaenau Gwent (Mr. Foot) was right to remind the House of the true history of the National Health Service, and it would be a calumny not to pay tribute to the immense role that Aneurin Bevan played in its creation. As for the 1944 White Paper, it is worth recalling that Winston Churchill tried to delay its publication, and had to be persuaded to publish it by Lord Woolton, the Minister of Reconstruction, on the basis that most of the compromises had been made by Labour Ministers in the coalition Cabinet.
Of course, many parties and people have contributed to the Health Service over the past 40 years. The genius of Aneurin Bevan, however, was that he understood that it was more than just a sickness service: that it was contributing to the unity of the country and to its values. In "In place of fear", he wrote:
Society becomes more wholesome, more serene and spiritually healthier if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves but also their fellows have access, when ill, to the best that medical skill can provide.

It is that wider dimension of the Health Service, which has crossed party political divides, that has made it impossible for the Government to dismantle the structure, the fabric, the values, the morality and the ethical principles of the NHS. What is important about this debate is that it is not a great ideological discussion about the virtues and deficiencies of the Health Service. We all know that there is now no possibility that the Government will break it up. The danger is that of benign neglect. That is why we must look to the future, and grapple with the problem of the financing of the service.
I am one of those who believe that there is no point in putting money into the Health Service until we are certain that the money will go towards providing a better quality of service, higher standards and, above all, the eradication of the substantial waiting lists, which must be one of the biggest deficiencies of the NHS.
I have no doubt, however, that we are all responsible for a serious underfunding of the service. We are now celebrating its 40th anniversary. Twenty years ago we were spending 4 per cent. of our gross national wealth on it, while the United States was spending a little over 5 per cent. Today, we are spending about 6 per cent., with the recently announced increases in nurses' pay and other expenditure, while the United States is spending well over 11·5 per cent. That discrepancy of investment in health care can be paralleled in most other European countries. We have not kept pace with their investment in health care, which is our most serious problem.

Mr. Forth: How much money?

Dr. Owen: The hon. Gentleman asks, "How much money?" Over a period of three years or so, we should be aiming to increase the percentage of our national wealth that we spend on the Health Service by a full 1 to 1·5 per cent. to 7·5 per cent., which will bring us nearer the average figure for Western industrialised democracies.
Even so, I believe that the NHS gives better value for money than any other health service in the world. The trouble is underinvestment. How can that be dealt with? The more that I have studied the Health Service, particularly over the past six months, the more I have become convinced that people in this country must be made more conscious of how much it costs. There is an extraordinary lack of understanding of how much we spend on it. Not many people realise that this year we will pay from our income tax—excluding the national insurance contribution—14p out of 25p in the pound. I would like the service to be transparent, with everyone knowing how much they paid for it.
The more that I considered the matter, the more I rejected moving towards an insurance scheme, for reasons that have already been cited. The service must be funded from taxation. Yet the more that I thought about it, the more convinced I became that we should have a declared, hypothecated health tax. Furthermore, because income tax is a buoyant tax, it would to some extent keep pace with the ever-increasing demographic and technological demands on health care.
Even more important, a specific health tax would allow the Department to operate a health budget. It is very difficult to run such a massive organisation—the largest single employer in Europe—on the basis of Treasury subventions on a month-to-month basis. Treasurers of district health authorities in February this year were living


in total apprehension, unable to know whether what would obviously be a substantial pay increase for nursing staff would be funded fully or only in part by the Government. It is an impossible managerial task to run a health service on such grounds. It has also allowed for a very artificial distinction between capital and revenue, and a grossly undercapitalised hospital building programme—which, to be blunt, all of us at various times have used as a manipulator of the economy, cutting back on the construction industry for wider economic reasons.
I come out decisively in favour of a specific health tax, a specific health fund and a considerable freedom from Treasury controls. But how can we meet the other criteria that I have laid down? If more money is to be invested in the Health Service, how can we ensure that it will be wisely spent, and that it will produce a Health Service based on the demands of the consumer rather than putting money into the hands of the providers?
The first problem with which we must grapple is waiting lists. We must give patients the right to move to another health district if they are faced with a long wait. That right must be exercised in conjunction with their GPs, but preferably in a way that will cause the least possible distortion. I also believe that the cost of not providing for such a patient when the waiting list reaches a certain level should be met by the district health authority in which they live. That would be a useful financial discipline. However, if a private health clinic can provide the necessary treatment or operation at no extra cost to the Health Service other than would be the cost of going to another health district, I believe that the patient should have the right to go to such a clinic. Such measures would provide immensely important financial pressures on Health Service managers and consultants to grapple with the resources available within their districts.
To be effective, the family practitioner must be part of the district health authority. The separation of the family practitioner committees from the budget of the district health authorities is a massive mistake: the two must be brought together. It is impossible to bring about even an embryo health maintenance organization—let alone health maintenance attitudes, which are even more important—until the family doctors see themselves in the same financial basket as the hospital consultant. That is particularly important now that the Government are clearly bent on cash-limiting the family practitioner budget. I understand their reasons, but the day that that is done it will be in the interests of the BMA negotiators to put the family practitioners into the wider pool of the Health Service budget, the hospital budget and family medicine.
The advantage of giving the patient the right to seek treatment elsewhere if there is a long waiting list is that——

Ms. Harriet Harman: Will the right hon. Gentleman give way?

Dr. Owen: The hon. Lady will have an opportunity to make her own speech later. I am trying to keep my speech brief.
The advantage of this system is that it is a most significant initial step towards an internal market. An internal market will take time to develop. I agree with the

right hon. Member for Aylesbury (Mr. Raison). Alan Enthoven's writings are by far the most important writings on the Health Service. He took as his remit that it was no good coming in as an American academic and transposing American medicine on to the National Health Service. He had to live with the history, traditions and customs of the Health Service, and the love and affection that many people have for its basis. Therefore, he did not try to challenge the ethos of it. He talked about the districts being like small nationalised industries, so that does not raise ideological issues between the two sides of the House. People may be against the internal market for other reasons, but there is no ideological issue to divide us.
Another matter that causes me great concern is AIDS. We are dealing with a pandemic in this country and in the world. The projections are difficult, but we may be facing as many as 25,000 deaths in the year 1992. Some people say that it may be less, perhaps 20,000, but that is still substantial. What are we doing about it? The answer is, not enough. First, we must face this as a public health issue. We have been down this route before and faced other public health hazards of great epidemic proportions—tuberculosis, syphilis, smallpox, yellow fever, cholera and others. Therefore, we have a corpus of knowledge of how to deal with epidemics.
The first and fundamental point is that what is said to a doctor, and what tests are undertaken by doctors, must be completely confidential. That is the hallmark of the system that we have operated. I find odd this reluctance to face the need for routine testing for the HIV virus. We have never asked people whether their blood should be tested by the Wassermann test for syphilis over many decades. We have got to know more about the HIV virus and to be frank about it. Since October 1985, all blood donations have been routinely tested—over 6 million of them. About 92 HIV-positive people were found and only three were not traced and counselled. We must not be afraid of this knowledge. It is difficult to handle when it happens. Doctors have to be able to advise people confidentially about the situation, but the only way to get control of this epidemic in our midst is to use the tried and tested techniques of public health. It must be made clear that this information is confidential. I can understand why certain groups of people, such as homosexuals, are anxious that this will lead to persecution. It must not, and it will not, because it will help us to control this epidemic.
The Government have not taken the drugs problem and the links between drugs and AIDS seriously enough. This is the bridge into the heterosexual community. In Edinburgh, the problem is immense. I know it is a difficult problem, but I believe that syringes should be provided free to addicts and that there should be a much bigger investment in the drug abuse programme. We have to face the problem of condoms in prisons. Because we pack people into prisons, we must face the fact that there is now a growing epidemic there. These are unpleasant and difficult subjects, and if we are to grapple with this epidemic we have to be braver. The Government led well with their television advertising, but they must go into some of these even more sensitive and difficult questions.
It has at long last been realised that alcohol is a social evil. The Royal College of Physicians wrote a report in 1987 called "A great and growing evil". It had first used those words in 1726. The statistics show that well over 6,000 deaths a year, 62 per cent. of serious head injuries, 66 per cent of suicides, and 50 per cent. of murders are all


linked to alcohol. Child abuse, baby battering and wife battering all have their roots in alcoholism. We must do something about it.
We are not taxing alcohol enough, partly because we fear the discrepancy between our VAT levels and those in the rest of the European Community. The way to grapple with that is to have a specific levy put on the drinks industry to help to meet the cost of the treatment of alcohol-related problems within the NHS. I suggest that the Minister for Health uses his existing powers to create a special alcohol service authority, under the Health Service, which will take over all the different alcoholic services, and try to give solving this problem a new dimension and thrust. It would he funded specifically from a new levy on the industry. That levy could allow us safely to reduce VAT, because the burden on the industry would be the same as the present levels of VAT. We must increase this burden as the spending power, particularly of young people, grows. It is clear that hooliganism is related to alcohol and the easy access to alcohol. It is a killer. It is the cause of more misery and violence in our society than anything else. We have been worried about advocating strong action on this for fear of being thought to be killjoys or somehow interfering with people's fundamental freedom. This is a delicate and sensitive issue, but it must be tackled.
I would have liked to talk about many other issues in the NHS. It is not about to collapse. It has many great attributes. It has a strength that goes way beyond what is said or done in the House of Commons. In my judgment, it could never have reached the point that it has reached now, 40 years on, without the dedication of millions of people who contribute to the NHS because they believe in it and think that it is fundamentally a good thing. They are not always looking for extra money or remuneration. They work far longer hours than they are scheduled to work and are paid to work. It is to them that we should be saying, "Thank you for 40 years of service" and it is to them to whom we should look when we assess the future. The Health Service needs change, but it needs change on the basis of a common understanding of all that is good within it. Many of us, in our personal and private lives, owe an immense debt to the Health Service. Let us hope, 40 years on, when the House debates the Health Service again, that people can pay tribute to what will happen between then and now.

Mr. Tim Yeo: I pay a warm tribute to the right hon. Member for Plymouth, Devonport (Dr. Owen) for making one of the best contributions to the on-going discussions on the Health Service that I have heard for a considerable time. I think that I speak for quite a number of my hon. Friends, and a number of my constitutency supporters, when I say that he is welcome on the Conservative Benches any time that he chooses to come over.
This is intended as a birthday celebration for the Health Service. We have, quite rightly, heard a lot about the history of the service, but I see this as a chance also to celebrate the present and look into the future. The Opposition are often keen to tell us about the bad case histories that they have come across, but I believe that almost all of us are aware that in an emergency the NHS is unbeatable.
Earlier this year, my daughter Emily suffered a brain haemorrhage. I cannot imagine any other system—private insurance or any other public health service—that could have worked so smoothly and satisfactorily as the NHS did in her case. I pay tribute to Mr. Robin Illingworth, at the neurosurgical department at Charing Cross hospital, and Dr. Mark Glaser, of the radiotherapy department, and also to the nursing and other staff, especially those in ward 10 south. Without their skill and care, and without the existence of the NHS, I have no doubt that my daughter would not be alive today. Although I have the good fortune to serve in the House, I am sure that there are millions of others who have had the same experience and the same reason to be grateful to the NHS.
Of course, we could examine many matters in this debate, but in the interests of brevity I want to make four suggestions about the subject that I hope the Prime Minister's review will deal with.
First, we need to pay attention to what the Health Service is for. It continually surprises me that there appear to be no clear definitions of the boundaries of Health Service activity. I remember before Christmas that my right hon. Friend the Minister for Health told a meeting that the third most common reason for admission to hospital in one health district was vasectomy. He added that many of the people admitted for that purpose had already had one vasectomy on the NHS, had had it reversed, but had changed their minds and were having their second vasectomy. Although the cost of a vasectomy may be relatively small, when we were being told that—allegedly because of lack of funds—people with life-threatening conditions were unable to obtain urgent treatment, that any taxpayers' money should be spent on providing second vasectomies was utterly absurd.
It is high time that we defined what functions the Health Service will provide at taxpayers' expense and what functions it will not. That argument is also relevant to the debate about the relative responsibilities of local authority social services departments and those of health authorities, where there still appears to be a considerable blurring of the dividing line.
I believe that the presidents of the three royal colleges would be willing to lead the medical profession in contributing to a discussion about where the boundaries should be drawn. In the evidence that they gave to the Social Services Select Committee earlier this year, they appeared to be happy to help my right hon. Friend if he wanted to define the role of the Health Service.
Having decided what the service should do, we should then find a better way of measuring how well it does it. I welcome the fact that some progress has been made towards better measurements of performance. We have progressed a little from the rather sterile, politicol debates that used to take place, with people trading statistics about how much was spent by whom in which year.
No person running a business would think of measuring the success of his business exclusively by reference to its turnover. As long as our arguments were confined to inputs, they told us remarkably little about the success of the service. More urgency needs to be applied to the development of better measurement of outcomes. Too many of the performance indicators that the NHS is developing are just activity measurements.
Obviously a necessary condition of good management is that we should know how much activity takes place in the different sections of the Health Service, but that is not


a sufficient condition. We must measure more accurately the health of people who have used the service. Until we do that, it will not be possible to sustain any argument about whether spending is adequate, inadequate or excessive, because we simply do not know how well the existing job is being done. I hope that a major part of the review's conclusions will be about improved measurements of outcome.

Mr. Nicholas Bennett: Has my hon. Friend seen the work done by Professor Alan Maynard at the university of York health economics unit? Professor Maynard has proposed quality adjusted life years as one way of measuring outcome. Will he suggest to my right hon. Friend that that is a matter that should be progressed?

Mr. Yeo: I have seen that work, and I believe that quality adjusted life years are one way in which we can measure the relative importance of embarking upon one course of treatment as opposed to another. It is worth recognising—it is a fact, which, of course, many practitioners are understandably reluctant to recognise—that whatever the level of funding of the service, and even if present expenditure was doubled, there would still be marginal cases where someone would have to say no. They would have to say that there were insufficient resources to do a particular operation or to offer a particular treatment. It is in such cases that the concept of the quality adjusted life year would be most relevant.
Before leaving the question of performance measurement, we must be aware, as my right hon. Friend the Member for Aylesbury (Mr. Raison) said, that the Health Service has become rather a producer-dominated service, and some providers of health care might be less than enthusiastic about the development of accurate measurements of outcomes.
Having decided what the service is for and how its success should be measured, ways should be found to improve its operation. Many sensible ideas have already been canvassed and, indeed, some have been mentioned in this debate. First, there is the move towards internal markets. I agreed with the right hon. Member for Devonport when he said that the first step towards improving the internal market is to give patients the right—in consultation with their general practitioners—to request treatment in another health district if, within an agreed period, they are unable to obtain treatment in their own district.

Ms. Harman: Does the hon. Gentleman accept that patients already have that right and GPs already have the right to refer their patients to other health districts? The problem is that all the districts have waiting lists for the same specialties. For example, all of them have waiting lists for general surgery. That is the main obstacle. There is already a cross-boundary flow.

Mr. Yeo: I do not agree with the hon. Lady. It is certainly possible for a general practitioner to negotiate the admission of his patient in a neighbouring district. I do not believe that the principal obstacle is the length of the waiting list. My constituency is relatively well served in health care, but it has a problem with orthopaedic appointments. It takes a long time for someone to obtain

an appointment with an orthopaedic surgeon. Other health districts have considerably shorter waiting lists. The problem is the funding of those patients. They do not cross district boundaries with accompanying funding. Therefore, the accepting health district is actually adding to its financial problems when it goes out of its way to solve a patient's problem. We need to ensure that patients cross district boundaries with the appropriate funding, which will open up the internal market.
My second suggestion for improving the way in which the service operates is to implement more whole-heartedly the Griffiths recommendations, many of which are extremely sensible, but have been implemented only in a half-hearted manner. We should start with the appointment of a high profile chief executive. I fear that very few users of the Health Service or, indeed, its employees could name the present chief executive.
On management structures, we should resolve the contradictions between the existence of a management board on one side and a group of regional health authority chairmen on the other, all of whom consider that they have direct access to the Secretary of State. I suggest—and I have reason to believe that this would not be unacceptable to some of the regional health authority chairmen—that those two structures should be consolidated in the management board, provided that the regional health authority chairmen are well represented.
My third suggestion is that we should treat nurses like policemen. In the police force, it has been a source of great satisfaction that many non-policing functions have been civilianised. The police authorities and the Home Office boast that they employ a large number of civilians, thus releasing expensively trained and highly paid policemen to carry out police work. The same should be true of nurses, who also are expensively trained and, at last, becoming better paid. We should make a virtue of ensuring that there are enough ancillary staff in hospitals to enable nurses to spend their time nursing. That would also improve job satisfaction.
My fourth suggestion is that we should consider the treatment of capital much more carefully. There are numerous irrationalities as between capital and revenue in the NHS's financial organisation, but the Health Service should be more careful about the use of its fixed assets. I acknowledge the efforts that have been made to release more surplus land, but many famous institutions in the City have ensured their future financial viability by moving three or four miles east to docklands. Why does St. Bartholomew's hospital not do the same? I dare say that the capital value of the real estate currently occupied by Barts, if sold and reinvested, would be sufficient to cover its revenue costs in perpetuity and that, apart from the consultants, very few people would be inconvenienced by such a move.
I commend to the House most warmly the proposals of Riverside health authority to consolidate its district general hospitals on two sites—one at St. Stephen's, Fulham road, and the other at Charing Cross. It is significant that closure of Westminster hospital has been supported by the consultants. They should be congratulated on that.

Mrs. Gwyneth Dunwoody: Is the hon. Gentleman aware that it is widely thought in the NHS that the three hospitals will be closed and that the land attached to St. Stephen's hospital will be sold for a private


hospital? That is not the way in which to consolidate health care in London or to provide cover for the population in the area.

Mr. Yeo: That is not the proposal which has been agreed by the district health authority. I have no doubt that my right hon. Friend the Minister will give his view on that in a few weeks' time.
I have left my final point until last deliberately as it is the least important. It is about money. The most important thing is to decide what the Health Service is for. We must then decide how well it is doing it, and then improve how it does it. Finally, we have the relatively minor matter of how it is financed.
There are many alternatives to the present basis of funding, but I have not seen much evidence to suggest that any of them will do much to improve patient care. The other things which we have discussed will, but I do not think that switching to an insurance-based system would make much difference. The taxpayer would pay less tax if we shifted more of the cost of health care on to the private sector, but my right hon. Friend the Chancellor of the Exchequer is doing pretty well at getting taxes down every year while putting more and more money into the Health Service.
I share the view that there should be a pluralist provision of health care. I want the private sector to grow, flourish and expand. There is every reason for us to support that—it reduces the burden on the taxpayer. I cannot see any great advantage, however, in offering taxation incentives to take out private medical insurance. Many people are already willing to take out such insurance without incentives, and I do not think that we need to promote private medicine in that way. If it is thought sensible to introduce some slight extension of charging, which is already accepted for prescriptions, to cover hotel services for better-off people, that would appear entirely inoffensive.
I hope that the Prime Minister's review will consider the four points that I have mentioned. Irrespective of whether it does, I believe that the message that will go out as a result of this debate is that we have a great deal to celebrate in the NHS, that we undermine its principles at our peril and that it is our job to improve a fundamentally sound structure.

Several Hon. Members: rose——

Madam Deputy Speaker: Mr. Speaker has already appealed to the House for short speeches. I repeat that appeal. Unless speeches are shorter, a lot of hon. Members will be very disappointed by 10 o'clock.

Dr. Lewis Moonie: There has been a surprising degree of consensus about the basic philosophy which underlies the NHS, and acceptance that there will be little change to it. I am sure that that is gratifying to many Opposition Members and to many people outside who have had considerable doubts about the Government's intention during the past few months. A series of leaks have floated out from the review of the NHS.
Following publication this week of the report by the Social Services Select Committee, I shall be even more delighted if the Minister of State says that he will accept

our conclusions. We could then carry the consensus to its logical conclusion. I have some doubt about that happening.
It is also generally agreed that the NHS is largely a sickness service. That is, after all, its role. It is the role which we have defined for it. Its role is to restore people to health if possible and to care for those whose health cannot be restored. It is scarcely surprising that the NHS does what we want it to do. It is also scarcely surprising that it does not do what some people think it ought to do, which is to promote health.
Health promotion is the role of Government, not of the NHS. It depends on many vague and general factors such as poverty, unemployment, damp, cold housing. Over-crowding and environmental deprivation. Those are the true determinants of ill health. The right hon. Member for Plymouth, Devonport (Dr. Owen) mentioned the role of alcohol and said that it is a major cause of suffering, ill health and death. I propose to say no more about that important subject now.
I shall confine myself to two areas of major change in the NHS—the change in organisation and the change in the level of funding supplied to it. I shall not say much about the early organisation of the NHS. It is well known that, like Gaul, it was divided into three parts—the primary care service, hospital services and public health services. They were united in 1974–75. Like most other reorganisations since, that one improved the quality of management in the NHS. It was changed again in England and Wales in 1980 by the withdrawal of one tier of management which, on balance, I think was a good thing. Finally, three or four years ago, Griffiths-style management was introduced.
I agree that, by and large, the change has improved effectiveness and efficiency in the delivery of health care. The service has been constrained, however, by the limitation on resources. There are many reasons for that. They are well documented in reports by the Social Services Select Committee. There is the demographic change about which we all talk and the need for 1 per cent. growth, be it in overall resources, as many of us argue, or in efficiency, as the DHSS tends to argue.
There has also been the increase, which is supposedly inexorable, in medical technology, the increase in Government priorities in certain areas and the growth generated by the increase in efficiency which the Government tried to promote by bringing in Griffiths-style management. That alone is surely the most important reason for the present problems. The NHS is a victim not of its failure, but of its success. We must remedy that if we are to allow it to grow and prosper.
We all agree that most health care in Britain will be provided by the NHS. That is fine, but we must give it the resources that it needs to do the job properly. As a doctor, I do not agree with those who say that demands on health care are infinite in the sense that we must always respond to them. We could produce immeasurable benefits in the health experience of people in this country by a relatively limited injection of additional resources into the NHS. Of course, we must control growth at the margins. That is Government's job and we do it directly through the supply side of that service. We must not constrain the NHS's resources so much that we are presented with the spectacle, as we were last year and as I fear may happen later this


year, of effective efficiency units being closed three months before the end of the financial year because there are no resources left to run them properly.
I am interested to know what the Government's review will produce. The leaks about which we have heard, as each scheme that has been touted has been discarded, suggest that the conclusion will be that we should perhaps give some people tax relief for their BUPA subscriptions, although that will scarcely make the earth move for most people in this country.
Many changes in organisation have been proposed for the NHS, as many hon. Members have mentioned. For example, everyone agrees that health maintenance organisations would be much better than the private system of care generally prevalent in the United States, but they would scarcely be a match for the best funded public health service in the world, as we have here. That would not be an improvement. Internal markets are all well and good, but the Minister has pointed to the lack of information, both financial and in respect of quality, required to enable an internal market system to work.
Although, if we take it to its logical conclusion, I can see the possibility of one hospital in central London providing one range of services and another hospital, fairly nearby, producing a different range, it would be a great deal different in the Highlands of Scotland if people had to travel 70 or 80 miles to have their ears examined because the ear, nose and throat department at one hospital had been closed down as it was supposedly less efficient than the one down the coast. I scarcely think that people will be enraptured when they see what the internal market leads to.
I do not believe that the NHS requires any fundamental change in its organisation at this time. We could probably consider some matters. For example, we could consider the role of its management board and its chairman and see how effective and efficient they are in promoting the wellbeing of the service for which they are responsible. We could look at the edifices that they run in London, full of civil servants, and work out how cost-effective they are and what they provide in the way of benefit to the people of this country. We could consider the role of regional authorities and see whether that needs to be changed.
We must certainly bring about the change for which the Select Committee has been asking for years, mentioned again by the right hon. Member for Devonport, to merge family practitioner committees with district health authorities. The only reason for maintaining a separate, parallel tier of management must be if we can prove that it is a more effective way of organising the service, and there is absolutely no evidence that that is the case. Those organisations must, therefore, become part of the same system and generate the savings that can be achieved by streamlining the management.
I do not propose to say anything else this evening other than to mention the fact that, this afternoon, I was given a petition which I intend to present to the House later. It bears over half a million signatures and was collected by the Royal College of Nursing. That is a sign of the true depth of feeling in this country about the NHS. That is one of the reasons why we are debating it today and why we tamper with it at our peril.

Mr. Ray Whitney: The measured contribution of the hon. Member for Kirkcaldy (Dr. Moonie) was in marked and welcome contrast with the hyperbole to which we were treated by the hon. Member for Livingston (Mr. Cook).
I should like to join in the tribute paid by hon. Members on both sides of the House to the dedication and achievement of so many people, past and present, who have served in the National Health Service. However, we must take this 40th anniversary opportunity not only to look back briefly at its origins, but to see the problems that we face and to give what signals we can to my right hon. Friend the Prime Minister and her colleagues in her review, as this is a fundamental juncture in the provision of a truly modern system of health care. Therefore. conscious of your entirely justified injunction, Madam Deputy Speaker, I shall return briefly to the events surrounding the birth of the NHS, to which my right hon. Friend the Secretary of State and the right hon. Member for Blaenau Gwent (Mr. Foot) have already referred.
It is important, so that we can take the issue out of the political dog fight in which it has lain and suffered for so long, to put it firmly on the record that, for very many decades, parties of all persuasions in this country have been, and continue to be, dedicated to a comprehensive, universal system of health care for all our people. The only argument concerns the mechanics of how that can best be delivered. In 1948, there was an argument about the method of delivery. The chief issue of substance was in the phrase they used in those days about whether the hospitals should be "nationalised".
That was not a direct Conservative-Labour fight, as I hope the right hon. Member for Blaenau Gwent will allow. It was largely a fight with the medical profession strongly in the lead. Historically, the contributions of the British Medical Association to medical advance in this country have not been glorious, starting with its opposition to Lloyd George's welcome reforms in 1911. The issue of the so-called nationalisation of hospitals went across the parties in 1945 and 1946. It was the published and authorised policy of the Labour party itself that the hospitals should be locally controlled and it was the firm advocacy of the then Lord President of the Council, Herbert Morrison, against Aneurin Bevan, who insisted that that was the way to go and warned and fought time and again in Labour Cabinets in 1945 and 1946 against the overcentralisation and bureaucracy that would be created by Bevan's structure. Bevan won and said, "No, we shall solve the problem. We shall find mechanisms in the future to cope with those fears."
In 40 years of trying, of Royal Commissions, of reviews, of committees and of changes of organisation, we have not solved those problems. We have not found the solution. That must give us pause, 40 years on, to consider whether there is a solution. The answer is that there is not. However, there is a way through because there is now another option for funding. Herbert Morrison was defeated at the time because no one could think of how to fund hospitals or organisations properly on a local basis.

Mrs. Dunwoody: With the greatest respect, that is a load of rubbish. Herbert Morrison wanted control of London hospitals because he said that he was in total control of local government here and could determine what went on


in those hospitals. Many of us never accepted that argument and we pointed out to him that some local authorities were controlled by the Conservative party. That is why he was defeated then, that is why it was right that he was defeated then and the idea that he is still alive and living in Walworth road is a load of rubbish.

Mr. Whitney: I am grateful for the hon. Lady's elegant contribution. I am sorry that she does not know and understand the history of her party. If we go back to the resolution passed by the last Labour party conference before the Second Reading debate in 1946, she will know that the Labour party was in favour of locally funded and organised hospitals.
I return to the question of funding which has bedevilled the Health Service ever since 1948. The right hon. Member for Blaenau Gwent did not bestow on the House another bit of history, the fact that his hero, Bevan, was complaining about the "cascades of medicine pouring down British throats", literally months after the Health Service started. So there have always been financial pressures and constraints on the Health Service. In real terms there has been a fourfold increase in spending over 40 years, but we still have problems. That is a sign that the financial structure as well as the organisational structure was fundamentally flawed when the NHS was established.

Mr. Nicholas Bennett: I, too, have been reading the records of 40 years ago, including Cabinet minutes of 1948 and 1949. The right hon. Member for Blaenau Gwent (Mr. Foot) did not mention that six months after the establishment of the National Health Service the right hon. Gentleman who preceded him in representing his constituency, Aneurin Bevan, had to ask the Cabinet for another £50 million. On 23 May 1949, the Attlee Cabinet discussed hotel charges for hospital services.

Mr. Whitney: I am grateful to my hon. Friend.
I hope that the House will accept that for 40 years we had had problems that have stemmed from flawed financial and organisational structures. It is only now that we have the opportunity of examining them afresh. I hope that my right hon. Friend the Secretary of State will bring courage and open-mindedness to this challenge.
The resources that are needed for health care are much greater than those that we currently devote to it, and there is a need for significant changes in the delivery system. The right hon. Member for Plymouth, Devonport (Dr. Owen) took up international comparisons, and I suggest that for the moment we forget the United States. It is a convention, when defending the Bevanite structure of the NHS, to say, "If we are not careful, we shall end up like the United States." Let us consider instead our continental neighbours, such as France, Germany, Italy perhaps, and the Netherlands. These are countries with which we tend to compare ourselves. On average, these countries spend about 9 per cent. of their gross domestic product on health care against our 6 per cent. Purchasing power parity is a more effective comparison, and if it is made we find that we are spending not much more than half of that which the Germans and the French spend.
I accept that in some respect the NHS is an efficient structure in terms of using resources effectively, but because of the absence of measurement controls it is most ineffective in many other areas. We cannot get away, however, with spending slightly more than half of what is spent by the French and the Germans and have the sort of

standards of treatments that they enjoy. It is a sadness that there has been virtually a conspiracy of silence. Our people do not know what they are missing. As the NHS has become increasingly a political football, the parties when in government have to say, "This is wonderful and we are wonderful." The British people are beginning to learn, however, what they are missing in the delivery of health care and what is available in other countries.
Let us not say that we need to spend as much as the Germans or the French. Let us say instead that we need to go only halfway in closing the gap. That involves additional spending of £10 billion, £11 billion or £12 billion. That would mean spending half as much again. There is no conceivable way in which we could produce that from the public Exchequer, notwithstanding a dedicated health tax or any other scheme that has been suggested by my right hon. and learned Friend the Member for Richmond, Yorks (Mr. Brittan) or by any Opposition Member. No other country has tried to spend that sort of sum through the public Exchequer. No other country would be silly enough to try it. There are ways, however, in which we could proceed.

Mr. Robin Cook: Will the hon. Gentleman give way?

Mr. Whitney: The hon. Gentleman gave way to me not once, but I happily give way to him immediately.

Mr. Cook: I was not aware that the hon. Gentleman tried to intervene in my speech.
I refer the hon. Gentleman to the German figures. He is making a comparison with Germany and saying that it would be impossible to increase our expenditure on health care. Why is it that the gap between public spending between the United Kingdom and Germany, in terms of percentage GNP, is precisely the same as the gap between private spending in the United Kingdom and in Germany? Why is he so desperately exercised about private spending and so desperately anxious to deny the case for increasing public expenditure?

Mr. Whitney: Because the funding structure in Germany is different from ours. The employers of those earning up to the equivalent of about £20,000 a year contribute about half of that which is paid to the German health care system. It is clear that the hon. Gentleman does not understand the funding structure in Germany, which is significantly different from that in the United Kingdom.
There is a solution to the dilemmas, but it is not to be found by dividing the nation by introducing public heal! h cover and private health insurance. That is not the way to go, for various reasons, some of which have been referred to already. That approach would not help the Treasury and it would not remove the pressures from the public health structure. It would lead to the significant problems that would result from two nations, which we must avoid.
We need to take up the solution proposed by a committee that was established by the BMA, of all organisations, taking account of my earlier remarks. The committee worked for two and a half years and produced an excellent report. Sadly, the BMA, reverting true to historical form, proceeded to ignore the committee's recommendations and put its report on the shelf. It recommended that there should be a health voucher or health credit system.
We must recognise the wonderful achievements of our Health Service and forget the mistakes which were made.


We must learn the positive lessons of foreign experience and apply them to our new structure. We can then provide a system that at last achieves what Herbert Morrison was unable to bring about but which the Labour party of 1945 wanted—autonomous local hospitals. That would enable us to do away with the superstructure of district health authorities, regional health authorities and all the other ineffective paraphernalia. I can assure the House, having been a junior Health Minister, that it is ineffective. Hospitals should become autonomous and funded by a health credit system on an insurance basis. That would put the consumer—the patient—in command with his doctor. The doctor and the patient would immediately have an incentive to turn to preventive medicine. That is what the Americans call wellness management, which is an asset that the NHS has never enjoyed. That would mean a significant change in the funding structure.
That change may seem to be radical, but the reality is that it would take us to what we have always wanted. With a well-funded basic level of health care, anyone who wanted to top up, as it were, for additional services—private rooms or special hospitals, for example—would be able to do so. We would have a truly national Health Service at a local level, and a well funded one. That would fulfil the objectives of the authors of the 1944 White Paper—they came from both parties and all the medical professions—and fulfil also the aspirations for the future.
The explosion of demand that will come is not generally understood. We have an aging population and economic pressures that come from technological advance, but more significant are the rising aspirations of our people—and they are justified in having them. The only way in which we can meet them and avoid the political Passchendaele that the NHS debate has become is to have radical rethinking now.

Mr. Ronnie Fearn: On the occasion of the National Health Service's 40th anniversary, I start by acknowledging Aneurin Bevan's achievements. At the same time, I pay homage to the well-known liberal, William Beveridge, who first conceived the idea of a National Health Service. His report was presented to Parliament in November 1942, which is perhaps the earliest date we have heard tonight. That report was and remains the cornerstone of the welfare state. Underlying its conclusions were three basic assumptions, of which the second was
a comprehensive health and rehabilitation service for the prevention and cure of disease and restoration of capacity for work available to all members of the community.
On the day that that report was published, 70,000 people queued for a copy of it, but it was not until July 1948 that the National Health Service was introduced. That was made possible because there was universal recognition that the community was responsible for the welfare of its members. There was a pride in national unity and a sense of community, and—if I may dare use the term—a consensus, not only in Government but throughout the country, that the better standard of health and welfare that the individual enjoyed, the more benefit would accrue to the nation.
That sense of community seems to be missing today. The Government's policies are leading us into division and

individualism of the worst kind. Survival of the fittest and the richest, obsession with individual responsibility, privatisation, and free market forces override consideration of any other matter. It worries me that, when it comes to our National Health Service, everyone seems to be playing into the Prime Minister's hands. We hear of this book and that book, and of this article and that article—all of them outlining new ways and methods of financing and organising health care in the belief that the country cannot afford a comprehensive National Health Service. That is nonsense. What we can afford is not an absolute; it is a matter of political choice and will. That is the crux of the matter. The Tory regime does not in its heart of hearts believe in an equitable health service, free at the point of delivery, because it has not committed itself to that principle and has not understood or committed itself to the need to fund the service properly.

Mr. John Maples: Can the hon. Gentleman give one piece of evidence to support his statement that Conservative Members do not believe in a National Health Service?

Mr. Fearn: The evidence is in the underfunding that has gone on throughout the whole of the regions and district health authorities, and I see that happening in my own health authority as well.
The Government's attitude is not the result of ignorance, because we know that they have estimated that the Health Service requires a 2 per cent. per annum increase above NHS price and pay inflation to meet demographic and medical changes. The service's under-funding has been a political decision. The Government have allowed the service to run into crisis—it is the Government's political ideology that poses a threat to a universal health service.
For 40 years, the NHS has served the nation well. Opinion polls show that the majority of the populace want it to continue and are willing to fund its recovery and growth from their taxes. For 40 years, our National Health Service has been the envy of the world. In terms of per unit cost, it is still the best value for money, and we should be building on that success and investing in it rather than considering any major changes.
Even in the present crisis, the hospital service is managing to meet most of the demands made upon it. That is being achieved through the dedication and skill of its staff. I am not denying that there is room for improvement in management, administration and efficiency—as has been mentioned before—or that there is a need for small structural changes. However, those can and should be achieved within the service's present framework and without losing the principle upon which it is based of equal availability at the time of need, free at the point of delivery.
It is that principle which has been threatened by the various schemes that have been thrown into the arena for discussion. I award full marks to the Prime Minister and to the Secretary of State for manipulating the situation and planting in the minds of the nation the seed that the Health Service is in need of massive surgery. We may consider, for example, the proposal to expand the internal market. That is seen as a way of enjoying the perceived advantages of the free market without altering the principle that the major part of funding should come from the public purse. There


is already a small ad hoc internal market at work, which has arisen from the need to reduce waiting lists and overcome the poor implementation of the RAWP formula.
Districts that are now below their RAWP targets buy in services that they cannot at present afford to provide. Any expansion of that market would leave such districts at an even worse disadvantage because they would be unable to compete with the better-off districts. The result will be stagnation and deterioration. Needless to say, those areas of the country that will suffer will be the under-privileged, the inner cities and rural communities.
The market ethos that the Secretary of State believes is here to stay will not create freedom of choice for all patients. It will create problems of accessibility for both patients and relatives, in ambulance and transportation services, and in co-ordinating after-care services and referral authorisations. In short, it will be an administrative nightmare.
The internal market also contradicts the idea that a computerised information system will allow the general practitioner and consumer greater choice.

The Minister for Health (Mr. Tony Newton): The hon. Gentleman probably sensed my mounting bewilderment and puzzlement as he went on with his script. What is really puzzling me is that I thought that I read a manifesto from one half or the other—or possibly both—of the party that the hon. Gentleman now claims to represent, the content of which was about as different from what he is now saying as it could conceivably have been. It was preaching the internal market in what seemed to me then to be a very ill-considered way. May we know whether this is the SLD's first massive U-turn?

Mr. Fearn: I can answer the Minister's question very clearly. It is not a massive U-turn. The right hon. Gentleman must have been reading The Independent, which obviously got wrong the speeches which have been made lately and in the past. I believe that that is what he has been doing.
An internal market may be some use in the short term in helping to reduce waiting lists, but it should not be considered as the basis of providing a comprehensive health care system for the nation. Such a market would prevent many districts from improving their own situation because the money that they should be investing in building up their own services would be spent on services from another district. That would result in a reduction of local services and uneven distribution of health care throughout the country, and it would add to the hardship and stress suffered by many individual patients.
The RAWP formula was introduced to provide equal opportunity of health care access for people at equal risk. If that scheme had been properly implemented and funded, and if a levelling-up rather than a levelling-down process had taken place, there would not be the need to discuss the internal market on the scale that it is being discussed today.
A number of proposals have been put forward involving various schemes for the use of health care vouchers. Unfortunately, my parliamentary, constituency and local council duties make it virtually impossible for me to digest all of the proposals contained in books and articles that hon. Members and my hon. Friends find the time to write. However, the suggestion is that the

individual be given a voucher enabling him or her to contract with an organisation or individual GP to provide the health care required, or at least some of it.
That arrangement raises a number of questions. How often will vouchers be provided? What will be their value? Will they be the same for everybody? How will they be distributed—possibly through the poll tax register? Who will be given vouchers to cover children's health care—mothers or fathers? Will the health organisation, private insurers or the individual GP be compelled to accept a voucher from any individual who approaches them, or will they be allowed to accept only those patients whom they consider to be a good risk, leaving those in most need of health care searching around for someone with whom they may contract?
As far as I can see, all such schemes leave the Government to provide insurance for the chronically sick, and the individual will be allowed to top up his or her voucher. That in itself tells us something about the schemes. The value of the vouchers will be such that organisations will not find it profitable to provide comprehensive cover and the chronically sick, who will have to rely on the Government to insure them, will get a raw deal.
Some of the voucher schemes, along with other proposals, envisage the setting up of some form of health maintenance organisation. In such systems, or those contained in other proposals, our NHS hospitals would be funded by those organisations or would become independent. All hospitals would compete for trade. That would result in hospitals specialising in the treatment that was most profitable. Emergency cases would be in danger of being turned away because the hospital did not have a contract with the patient's organisation—as happens in America—or because the patient was not covered for the treatment required. Health care in the nation would rely on cut-throat competition. A voucher system would seem to be a minefield.
It is reported that the Government are backing down from some of the more radical proposals that have been put to the review body. I can only hope that that is the case. Indeed, in his speech to the Centre for Policy Studies MSD foundation symposium on 17 May 1988, the Secretary of State implied just that. He said:
It means that we will not make access to decent health care dependent on the ability to pay for it. And we want to retain the comprehensive coverage provided by the NHS, so that the old and the sick are relieved from anxiety about obtaining the care and treatment they need.
I should like to believe those words in their entirety, but the recent changes in social security and housing benefit have shown us just how the Government relieve the anxiety of the old and sick.

Mr. John Redwood: Will the hon. Gentleman give way?

Mr. Fearn: No. I have given way twice.
The Government usually pull the rug from under the feet of such people. I put it to the Minister that the only way to achieve his stated objectives is to leave the NHS intact and to provide it with adequate funding.
Other less radical options are tax incentives and the choice to opt out of a national health tax to encourage more people to take out private health insurance. I am not opposed to the private sector per se——

Mr. David Evennett: Will the hon. Gentleman give way?

Mr. Fearn: No.
I have no wish to deny the freedom of choice to enable those who have the desire and the means to pay separately for private treatment to do so, but that should not reduce the freedom of NHS patients to obtain good health care by reducing the resources available to the service. We are all aware that any expansion of the private sector, which to date does not offer a comprehensive service and tends to take the profitable cases only, will only result in depleted resources to the NHS and a two-tier health system will come into existence.
The private sector has been allowed to expand without consideration of the effect on the NHS. There should be more effective control and current and future plans should be compatible with the services of the district health authorities. The private sector should contribute to the training of health care staff at basic training and postgraduate levels. Perhaps the Minister will tell us more about that. It should be required to participate in studies of epidemics and similar research as required. The private sector should be seen in terms of a partnership with the NHS, not in competition with it, and should not be allowed to dictate the terms or reduce the capacity of the NHS to provide a free and universal health service.
An individual's right to choose private health care should not reduce his or her obligation to the community. People should not be allowed to opt out of their state contribution. Good or bad health is not something over which the individual has complete control. Many illnesses are the result of living in society, or, should I say the community, to prevent confusion on the Prime Minister's part. An individual does not live in isolation. The community as a whole has a duty to provide a health system that is equally available at the time of need, is of acceptable standard to all and free at the point of delivery. I am not suggesting stagnation. Let us look at the NHS to see what minor reforms can be carried out, but let us ensure that those reforms do not result in a depleted second-rate service, but rather in a revitalised, community and patient-oriented service.

Mr. Evennett: Will the hon. Gentleman give way on that point?

Mr. Fearn: No.
Such a service would benefit us all. The country cannot think otherwise.

Sir David Price: In the interests of many hon. Members who wish to speak, I shall be as brief as possible; so I shall not attempt to answer the hon. Member for Southport (Mr. Fearn), although I would be more than capable of doing so.
The hon. Member for Kirkcaldy (Dr. Moonie) is no longer in the Chamber, but he said that many of the problems facing the NHS at the moment arise from its very success. If one looks at the total expenditure, corrects it for inflation and applies it to the population—in other words, the expenditure in real terms per head of population—one will find that it has gone up three times since the foundation of the NHS. Yet most of us members of the Select Committee would say that that is still not enough.
In speech after speech on the Floor of the House, I have pointed out the various factors which lead me to the conclusion that we are going through a period where the increasing demand on the service should be measured in exponential terms. I shall not repeat any of them this evening. But we cannot get away from the fact of increasing demand. There are those representative bodies, such as the BMA, who have asked for a 2 per cent. growth rate, but that, in my opinion, will not be enough. I have stated my position and stick by it.
Let me come to what I believe to be one of the greatest successes of the NHS that has hardly been touched on today—the great advances made in primary health care. We in the Select Committee did our own study of primary health care. We were impressed with what we saw. In our report, we said:
We have been impressed by many examples of good practice and innovative schemes for improving service to particular client groups—for example, children, or elderly, or mentally handicapped people.
We went on later to say:
We doubt whether any major new legislation is called for and hope that the government will not seek to impose blanket plans for changes in services indiscriminately.
We stand by that.
It was interesting, too, that Sir Roy Griffiths, in his report on care in the community, drew attention particularly to the positive role of primary health care. Again, in the interest of everyone else, I shall not read out what he said, but it is all there on the record.
We are getting much better value for public money in primary health care than most people recognise. People do not recognise how good that value is. When, on the Select Committee, my colleagues were good enough to come to my patch in Hampshire to talk to our family practitioner committee, which is the largest in the country serving a population of 1£5 million, we found that the cost per patient of that service last year was £69. The service includes all the necessary drug therapy. I challenge anyone to find any other western country which provides primary health care of that standard at that price.
My advice to my right hon. Friend the Secretary of State is to cherish what we have achieved in primary health care. Indeed, his White Paper led in that direction. Let us build on our success and develop the service further.
That takes us straight to the second aspect of the future of the NHS to which I wish to draw the House's attention, which is likely to be the biggest growth area of all, and that is what we loosely call care in the community. Let me give one illustration from my own Wessex health region. We have been told that during the next nine years the number of people aged 65 or over will increase by 11 per cent. Far more significantly, during the next nine years, the number of people aged over 85 will increase by 50 per cent. In absolute numbers, there will be 21,400 more people over the age of 85.
Let us now consider just one aspect of the aging process. We know that on average the prevalence of senile dementia in the elderly is between 5 per cent. and 10 per cent. in those over the age of 65, and about 20 per cent. in those over the age of 80. We also know that at present no treatment can prevent, arrest or reverse senile dementia.
I use those figures simply to illustrate the caring dimensions of the increasing number of very old people in our nation. There is no way that institutionalised care will be able to cope with that extra burden. It cannot cope with it now, although it makes a very important contribution in


handling the more difficult cases. The responsibility in practice rests with families and relatives, supported in part by the community.
The response to how we are to handle more very old people seems clear—care in the community. It is also clear that as a nation we must put more resources into care in the community. I realise that such claims for extra resources have to be made against the background of other urgent claims for extra public expenditure for other equally worthy causes. I am confident that we will get extra expenditure. I am equally confident that whatever increase we get will be insufficient. Such is the nature of our problem.
Ultimately, the deficiencies in public provision will be made up, as they have always been, by individual families and individual people doing their personal best for their own people in need. In other words, the slack will be taken up by the private carers. There are far more private carers than all the professionals added together providing health care to our fellow citizens. There is nothing new about that, it has always been so, but it suggests that we should do more to help those private carers. There are between 1 million and 2 million of us—we do not really know how many. Therefore, services such as home helps, care attendants, meals on wheels and respite care are every bit as important as new acute beds in geriatric wards.
Finally, may I make a brief observation about the structure of the National Health Service. From what I have said it will be clear to the House that I have a preference for the localised rather than the centralised; for small over large and for local services over distant services. It is also clear from the history of the Health Service that its aims could have been fulfilled under a different structure. It is arguable whether a localised model would have worked better. However, it is clear to me that we cannot change basically our structure, for two very simple reasons.
First, as long as 83 per cent. of the income of the National Health Service, and all its capital, comes from the taxpayer through the Treasury, a centralised system of control and accountability inevitably follows. I hate to think what the Public Accounts Committee and the Audit Office would do if my right hon. Friend the Secretary of State and his permanent secretary did not remain in their positions of direct accountability to those great offices. In fact, they would do their nut.
Secondly, as my right hon. Friend the Member for Aylesbury (Mr. Raison) reminded us, we expect the Secretary of State to be personally accountable to the House in detail for the manner in which the National Health Service delivers health care to each of our constituents. So long as that accountability remains, the system must he based on central political control. In my judgment, that is an inescapable political factor. I see the right hon. Member for Blaenau Gwent (Mr. Foot) nodding his assent.
Like every other hon. Member in this debate, I believe that constructive changes should be made in the running of the Health Service. However, I do not think that there is any necessity to pull the National Health Service up by its roots and replant it differently. I would advocate a policy of gradualism based on a programme of persistent improvement. I would caution against a policy of revolution based on a programme of instant convulsions. I have never been keen on the general use of ECT, and certainly not for the NHS. I would remind hon. Members

impatient for change of Aesop's famous race between the tortoise and the hare. It was the tortoise and not the yuppy hare who won.

Mr. Frank Field: Like other hon. Members, I salute those who have worked in the Health Service and those who currently do so. It is interesting that if one looks at the motion and the amendment—although from listening to the speeches so far it seems that we have not been paying much attention to the Order Paper—one sees that there is a considerable amount of agreement. Indeed, if I had not disgraced myself the other day by voting twice about whether freemasons should have to declare an interest when joining the police, perhaps there would be a case for voting on both sides tonight.
As well as saluting the people who have contributed to the state of the nation's health, let me begin with a personal comment to the Secretary of State. It is the first time that I have been in the House and witnessed him in much better health. I am pleased to see that. I also compliment him on his performance today and on the clever way in which he tried to build a consensus about the evolution of the Health Service during the past 40 years. For once, I disagree with my right hon. Friend the Member for Blaenau Gwent (Mr. Foot). I want that consensus message to go out from the House. Should the Prime Minister's review suggest otherwise, we shall know the changes that have taken place and that it is not part of the pattern to which we are accustomed.
I further compliment the Secretary of State because he has to face my hon. Friend the Member for Livingston (Mr. Cook). I do not think that I do a disservice to my other colleagues on the Front Bench in saying that my hon. Friend the Member for Livingston has emerged as our most powerful spokesman in criticising the Government. It is no easy task for the Secretary of State, certainly when he has not been well, and I am pleased to see him in much better health.
I wish to make only two brief comments. First. I have to confess that when I became Chairman of the Social Services Select Committee I knew next to nothing about health. Therefore, I was fortunate enough to have an open and empty mind. There can be advantages in having an open and empty mind in that sometimes one asks questions that are not asked by those whose minds are cluttered with unnecessary facts. In coming new to the subject, I was struck by what we did not know about the performance of the Health Service. We can consider the national picture—the global GDP figures that hon. Members have rightly mentioned. We can look at our morbidity figures and we can draw the general conclusion that the National Health Service serves us exceptionally well. If we consider particular hospitals and forms of treatment, and we make comparisons between regions arid localities, we would be hard pushed to provide any clear answers other than that we hope that the Health Service is doing us proud.
If we are interested in efficiency, and the Opposition are as keen to have efficiency in public service—or what is left of it—as the Government are, we certainly need information, and currently we do not have that. If this Government, or any other Government in the immediate future, are anxious to increase efficiency they must do it in a crude way and must apply cash ceilings. They hope that


by applying those cash ceilings people will scramble about with a bit more efficiency, perform more effectively and that the service will benefit. There is much to point at under the Government's stewardship to show that that has occurred.
To address myself directly to the Secretary of State, there is a danger that if there is only that crude method of controlling expenditure and trying to enforce efficiency, one can get it wrong. I can go further and say that one will inevitably get it wrong by the very nature of the exercise. Therefore, given the crudeness of the method of control, it is incumbent on the Secretary of State and the Government to look carefully at those points in the service that are showing pressure or may become flashpoints.
The Select Committee tried to highlight two of those flashpoints. We complimented the Government in a positive way—unlike some of the responses we receive for our reports—on the nurses' pay award. We also pointed to some of the difficulties in implementing that. If that is not to turn sour, if it looks as if the Government will not be able to fit their regrading reviews within the budget for which they are seeking approval, it will be necessary for them to come back to the House and ask for additional funds. I hope that all hon. Members will support the Government's request for any additional funds they need.
The other immediate flashpoint will be covering the pay award for the non-nursing and medical staff in the NHS. I know the argument well because one has heard it so often. I know that while negotiations are taking place the Government cannot say that they will meet the entire bill—as if the Whitley councils are somehow mysteriously independent of the Government. Surely the message is clear to the Government. When the Whitley councils report, the pay awards must be met in full if the Government are not to face the problems they faced last year where there were cuts in services and ward closures. I put that warning gently to the Government. When operating the crude policy of cash ceilings and trying to enforce efficiency—the only option open to us—the Government must be sensitive and quick on their feet when they see pressure points developing.
I disagree with my hon. Friend the Member for Suffolk, South (Mr. Yeo). I call him my hon. Friend because he is on the Select Committee with me. He said that we do not know whether the service is underfunded. That is partly true; we cannot come up with the exact figures. I know why he put his argument in the way he did. However, we can use our eyes and the evidence to see whether the service is being renewed in the way that we want and whether it has the resources to develop at the beginning of the next 40 years in the same way as it has developed over the past 40 years for which many of us are claiming credit. On that simple basis, it is clear that there is an underfunding.

Mr. Yeo: I will not damn the hon. Gentleman's career by calling him my hon. Friend, although he has probably damned mine. Whether or not we disagree about the evidence that the Health Service is currently underfunded, I hope that he will agree that if new funds are to be put in by the taxpayer, it would be useful to have a better measurement of how much value for money is achieved.

Mr. Field: I agree with that. I have not ruined my hon. Friend's career. His independence of mind and ability have

finished his promotion chances. There is little I can do to match that. [Laughter.] I did not mean that to be funny. Sad to say, it was a serious point.
Although the Government have many things to say that are to their credit, they have difficulty in reading clearly Select Committee reports. When our committee talked about underfunding and a need for increased resources, we did not ask for money to be thrown at the Health Service. We asked for increases of resources to be specifically linked to certain projects, for those projects to be monitored and for resources to be withdrawn if we found that they were being misused or spent on other items of necessary expenditure. We did not ask the Government to throw money at the problem, although money has a part to play. We talked about four areas.
First, in so much of the debate, both sides seem to be speaking the truth. The Government's record on their hospital building programme is not a bad record to look at. However, the Government's programme on repairs to existing buildings is an area of considerable concern. During the visits that the Select Committee has made people have made their points plain to us. If one can obtain lump sums for large capital programmes, one is all right. However, there is great difficulty in obtaining the necessary capital to undertake a steady programme of repairs. Unless we are extraordinarily lucky, all of us who visit hospitals see that we are building up an enormous backlog in the repairs programme. That is part of the underfunding and we want funds to be specifically targeted to that.
Secondly, there has been mention already of community care. My hon. Friend the Member for Livingston talked about the cruel policy upon which we are embarked of throwing people out of institutions without any back-up because it was thought to be the thing to do. I saw that in my constituency recently where somebody left the Cheshire hospital after 34 years. He has been cut off by his family, except his sister. He sleeps for only an hour and a half at a time, he smokes and drops his cigarettes all over the place. His sister is almost at the point of breakdown. Until that man was returned to hospital, that woman was providing community care. To say that putting such people into bed and breakfast hostels or back on to the street is community care is using language in an obscene way. My hon. Friend the Member for Eastleigh (Sir D. Price) was right to say that the programme of community care is not to cut the bills but to change the direction of spending and probably to increase it. In the long run that is necessary. However, if we are to receive community care only on its current scale, many of us would prefer to see our constituents remain in those dreadful long-term hospitals than have to face life outside.
Thirdly, the Select Committee also made a plea about equipment. We talked about replacements and about taking the technology up market. We asked not for money to be thrown at that, but for areas to be specifically located.
Fourthly, we mentioned information technology. Although I have learnt a lot over the past six months and have been impressed by the skill of Select Committee members and people outside, it was the Secretary of State who made the most interesting point, if the Sunday Times reported him correctly. I am responding to what it said were his comments, which were that it is possible to develop markets that are not governed by profit and are in the public sector. That should be a starting point for the


Opposition's debate. For that to be effective, we require a range of information that we do not have at present so that we can build up a public ethos about service, the like of which we already have in the NHS. If we could get the ongoing capital programme to see that the information technology in the NHS is brought up to the standard in some of our businesses, we could approach the next 40 years of the Health Service in better heart than some of us are in at present.
I have tried to be fair to the Government's record but it is interesting to see a Government who have talked about cutting public expenditure cleverly claiming that they spend more on the public sector than we do when in office. All credit to them. The Government have been elected three times on a programme of cuts in the public sector, targeting help, moving away from universal provision in the Health Service and denying the basis of equal citizenship that everybody in Britain looks for from the NHS. So the Government cannot blame us Labour Members if we look sceptically at some of the statements they make.
I hope that in this short contribution I have not strayed into the Select Committee's next report, as have some members of the Committee, but have related our past report, which is mentioned on the Order Paper, to one of the current crises in the Health Service. It is a crisis that we are debating at a time of celebration of the massive success of the Health Service. I hope, too, that I have pointed one or two ways to the future so that, as the right hon. Member for Plymouth, Devonport (Dr. Owen) said in his impressive contribution, we take measures to ensure that hon. Members 40 years hence may have grounds to celebrate the previous 80 years with as much gracefulness and joy as we are celebrating the past 40 years.

Several Hon. Members: rose——

Mr. Deputy Speaker (Mr. Harold Walker): Order. I remind the House of the earlier appeal for brief speeches.

Dame Jill Knight: The financial memorandum part of the National Health Service Bill 1948—I have a copy of it here which I obtained from the Library—estimated the annual cost of the Health Service at £152 million. In the ensuing debate one hon. Member warned that the cost just might double in 20 years, but this contrasted with the view of various so-called experts, including Lord Beveridge, to whom reference has been made, that the cost per annum would fall. Lord Beveridge thought that as everyone became more and more healthy we would have to spend less and less, so it would be a case of diminishing need. How wrong he and others were.
In 1948 the cost was £152 million per annum; in 1988 it is £23,500 million. It might have shaken even Aneurin Bevan if he had been told that in 40 years it would have gone up that much, although I think that I should remind Opposition Members, because it adds an interesting footnote to some of the things they have accused us of today, that he said in the Second Reading debate:
it has been the firm conclusion of all parties that money ought not to be permitted to stand in the way of obtaining an efficient health service." [Official Report, 30 April 1946; Vol.422, c.43.]
He said "all parties". I would agree with that, but whose money are we talking about? It must be the Exchequer's

and the taxpayers'. Where the sick person has no money. or only some, or wishes to use the Health Service that money must be made available and there must be no doubt in this House or elsewhere that I and my hon. Friends are totally committed to the continuance of the Health Service. Never would we tolerate, for instance, the American system. The one part of the speech of the right hon. Member for Plymouth, Devonport (Dr. Owen) with which I did not agree was where he seemed to praise the American system because they spend more of their gross national product on health care. He did not mention the fact that it was more of their own money and not the American Government's money. That is a rather important point when one is making the comparison.
The truth is that for a lot more money the American health service is not as good as ours. In that country one member of the family can have a motor accident or a long illness which requires many months or even years of care and that family can be bankrupted by the costs to them. No hon. Member could possibly support that sort of system here. So of course there must be continuing care, free for all who need it and cannot pay.
It is fair to say that the situation has completely changed since 1948. We are a far more affluent country. In those days it was quite rare for a family to have one car, and a two-car family was extremely unusual. Now, it is very commonplace indeed. We see families in which the mother has a car, the father has a car and their two or three children each have a car. There is so much evidence of a very greatly increased standard of living. People did not take foreign holidays very often in 1948. Home ownership is now much wider, as is share ownership. One could go on and on. But with greater affluence there can be no real reason why those who can easily afford to do so should not pay a bit more towards their health care, and much more money is undoubtedly needed for the NHS.
I do not believe that we can tackle the situation by further efficiency drives, although I pay a tribute to those. I add my voice to the voices of others who have said that value for money in the Health Service must be ensured. We have very inadequate methods of defining performance in the Health Service. We have 400 performance indicators. They can tell us staff numbers, types of operations performed and the general costs, but not one of them can tell us the cost of an operation in hospital A as compared with the cost in hospital B. We need to know these things.
It is right to say, too, 40 years on that we have a better Health Service than ever before. To those who ramble on about the crumbling Health Service I can only suggest that they look at the facts. The extension of health care today is quite incredible. We have far more sophisticated medical techniques, much cleverer drugs and infinitely more complicated machines, such as lithotriptors and scanners of all kinds. There is vastly more detailed research and people are being treated and cured today who would have been sent home to die only two years ago. My right hon. Friend the Secretary of State referred to the diseases that have been eradicated since 1948. Crumbling Health Service, my foot; it is a wonderful Health Service.
However, the financial implications of all this are incalculable. These much more sophisticated techniques take a lot more money, as do the very much cleverer drugs and the complicated machines. I gather that the cost of these has gone up far in excess of inflation. I believe that the financial implications are almost impossible to put together. And added to those we have the enormous


implications of acquired immune deficiency syndrome and the money that we have to spend on drug addicts. I would not add alcoholism, as the right hon. Member for Devonport did, because we spent money on alcoholism in 1948. I am talking about the new sums of money that we are having to find.
Of course it is right to refer to the tremendous amount of money that must go to caring for the elderly, and if it were not for private nursing homes we should be in terrible trouble.
I do not believe those who say that we can solve all the problems by tossing in a further £500 million or £1 billion per annum. It is not possible to say how much it will cost to meet all the needs of all the people as those needs arise. Nevertheless, I say most earnestly to my right hon. Friend the Secretary of State that our aim should be to treat all seriously ill people at the time when they need treatment. That is more important than keeping to a budget. This is the great dilemma. Do we, with all the extra techniques that have been developed, treat the people who can be treated, or do we keep to the budget? There cannot be any answer other than that we treat sick people, and expand the budget. If we have to expand the budget, so be it and we have to accept that lesson. One of the doctors at the Queen Elizabeth hospital in Birmingham said that he could treat all his liver patients now in the renal department if he had not overridden the budget already. We have to expand the budget and that must be recognised.
Such problems are not ours alone. This week, the British Medical Journal referred to the fact that Norway, West Germany, France, the Netherlands and New Zealand are busily reviewing their health systems because of the problems to which I have alluded.
I want to make one or two suggestions. I believe that the public are prepared to pay more money for the Health Service, but they must see that what they pay goes to the Health Service and does not disappear into the maw of the Exchequer. They do not trust the Exchequer and believe that the money will disappear, but they will gladly pay for direct health care. There are many ways to raise money, such as the voucher system and lotteries. I had thought that lotteries made only a small amount of money, but I had evidence recently that £1 billion could be raised each year. It is money that is there to be taken and it is right that we should do it.
There should be charges for hospitals for those who can afford them. It is the right thing to do. It has been estimated that if a charge of only £25 a night was made for those who could afford it—in the old days the almoners could tell us which people could afford it—that would bring in about £2,000 million a year, minus what it would cost to collect. One could not find a hotel for £25 a night. That £2,000 million is an enormous sum and hospital charges should be considered further because people are ready to pay.
Local functions for local hospitals are a very good idea. Those functions may be held for special causes, such as a CAT scanner or for the Birmingham children's hospital. The generosity of local people for every single local cause is undoubted. They will dig deep into their pockets for any call made by the local hospital. We should consider that further. It is difficult for patients to give money to a

hospital to thank it, except through the league of friends. They should be able to make a direct contribution to hospital needs.
People who wish to use private hospitals—and can afford to do so—should be encouraged. I disagreed with my hon. Friend the Member for Suffolk, South (Mr. Yeo) when he said that that would not take a burden off the Health Service. It would take a great burden off the Health Service. I have mentioned already what the private sector does for the elderly. There is a lot of co-operation between the public and private sectors, such as the presentation of a lithotriptor. In some areas, the Health Service is being helped a great deal by the private hospitals and that is a very good thing.
We should recognise how unpopular it is with the public that yet more administrators are employed. In Birmingham, we have been threatened with the closure of a women's hospital yet, at the same time as that closure was announced, the authority asked for £40,000 more a year for two extra administrators. It was very unfortunate that a hospital should be closed while two extra administrators were employed. I do not deny that there is a need for administrators, but more time should be spent in explaining to the public why administrators are needed and why they are not necessarily the big bad wolf. Some of them make the hopitals run more efficiently. However, people do not like the fact that we are spending money on administrators and we should recognise that.
We must have balance in all things. Medical secretaries have been underpaid for years and something should be done about that. No consultant could operate properly without his medical secretary. I suppose that they are administrators of a sort.
I should be letting my area down if I did not refer directly to two of our major worries in Birmingham. At the Queen Elizabeth hospital, the great teaching hospital in my constituency of which I am very proud, a quarter of the beds have been closed. Because it is a teaching hospital, there is another worry: one cannot teach medicine to students when there are not enough patients to show them. If something is not done, we face the prospect of an end to all medical teaching at the hospital in October.
Twenty cancer victims a week are being turned down for admission and that worries me deeply. I should explain that they receive examinations; it is treatment that they cannot get. I reiterate the major point that I wanted to make. If it has to be a choice between finding more money and denying desperately sick people treatment, we must find more money.

Mrs. Margaret Ewing: Like all the other hon. Members who have spoken, I extend my warmest greetings to the National Health Service on its 40th birthday. On behalf of my colleagues in Plaid Cymru and the Scottish National party, I express the warmest wishes that it will enjoy another 40 successful years and thank all those who have worked, and all those who now work, in the Health Service.
We have heard some interesting historical analyses, and I have listened with interest as the debate has moved back and forward across the Chamber and attempts have been made to claim credit for the National Health Service. That has seemed to me in some way to detract from the debate. As someone who has never been a member of the Labour


party and who has no intention of becoming a member of the Labour party, I believe that historically credit must go to the post-war Labour Government for the work that was done and for the single-mindedness and dedication of the men and women of that era who ensured that the legislation establishing a National Health Service as we understand the term reached the statute book.
Many hon. Members, myself included, come from the generation of peace babies and we grew up with the National Health Service. Part of the problem that we have faced over the past 40 years is that many of us have tended to take the National Health Service for granted. There has been an element of apathy in the assumption that what we expect of the National Health Service should be readily available.
I have great personal cause to be grateful to the Health Servious because in my early teens I contracted tuberculosis—a disease that would probably have killed me 20 years earlier. I was in hospital for 13 months and I was given expert treatment. As I lay in plaster from my neck to my toes, I had a whole series of very effective modern drugs administered, and here I am now—a fairly healthy specimen, I think. [HON. MEMBERS: "Hear, hear."] My father was a farm worker, and if he had had to pay directly for that treatment it would not have been possible. In considering the National Health Service, we must think of people who are on such low incomes that they cannot possibly afford such essential treatment.
With my colleagues in Plaid Cymru and the SNP, I believe that the allocation of money to the National Health Service is part of the political decision-making process. There are political priorities. We have heard hon. Members suggest new ways in which to fund the National Health Service. The hon. Member for Birmingham, Edgbaston (Dame J. Knight) has just suggested that people would be prepared to pay more for the National Health Service if they knew where their taxes were going. We can take that to its logical conclusion and argue the Government's political priorities. We can ask people how much they are prepared to pay in taxes to ensure that the NHS exists on the level that we want. I believe that they are prepared to pay much more but would say that the Government's priorities are such that they have no guarantee that the taxation revenue will be spent on the NHS. I know where the Government's priorities lie on the funding of the NHS or of Trident or cruise.
Over the past year or so, NHS workers have asked for only £2 billion—a small sum in the context of the Government's overall budget—yet their request has been rejected. Because of the Government's lack of political priorities, they have denied the Health Service the funding that is its right. Central taxation is a method of funding the NHS which we happily endorse. That is the view of people generally and is not unique to the House. Instead of redistributing wealth and ensuring that money was available to cater for the needy, the Government in their Budget gave handouts to the 20 per cent. richest people and denied the NHS access to central taxation.
It is always interesting in debates on the NHS to note what happens when we talk about the Scottish dimension, because of the difference in administration between England and Wales and Scotland. I am pleased to see here the Under-Secretary of State for Scotland—the hon. Member for Stirling (Mr. Forsyth)—and pleased also to

see the hon. Member for Mid-Worcestershire (Mr. Forth), because it always seems right when a Scot is speaking to have a Scot basher sitting opposite.
It is usually argued that the Health Service in Scotland has a higher budget than the Health Service in England and Wales. The level of underfunding in Scotland is less acute than in England. According to the British Medical Association, estimates of the difference vary between 9 and 25 per cent. The BMA's survey shows
that the NHS in Scotland is working hard to stand still
and highlights a number of deficiences.
Cash limiting on equipment purchases has resulted in difficulties in replacing worn out and broken equipment.
The BMA refers to
poor building maintenance and consequent deterioration in the fabric of many buildings and difficulties in recruiting and retaining medical secretaries and medical laboratory and scientific officers.
As hon. Members have been keen to talk about value for money, it is worth pointing out how the money spent on the Health Service in Scotland benefits the rest of the community. In Scotland twice as many medical students are taught as in England and Wales; hospital rates bills are almost four times higher. There is less private medicine, hence a greater dependency on the Health Service. There are vast rural areas in Scotland where, obviously, expenditure must be higher to cater for the local communities. If Scotland needs to spend a great deal of additional money on the NHS, it is perhaps because it has high records in terms of unemployment, bad housing, lack of facilities and poor environment—the issues mentioned by the hon. Member for Birkenhead (Mr. Field) as factors creating many of the problems that necessitate having a Health Service. The Health Service in Scotland is effective. We want it to be maintained. We have a commitment to ensure that taxation is raised centrally to ensure its continuance.
We are all worried about care for the elderly. Those of us who have read the Griffiths report recognise that it is one of the most significant documents on this issue produced in recent years. All of us are sons or daughters and have individual responsibilities towards our parents, but collectively we have a responsibility in society to ensure that a service is available to the elderly.
All of us believe in community care, to which much reference has been made. It is not enough to cast people out into the community and hope that they will survive somehow. It is important to ensure that a variety of facilities is available to cater for the individual needs of our constituents. The Voluntary Services agency in Aberdeen, which is an important agency in the Grampian region, has laid down a series of principles of community care. First, there are the client's individual rights. Elderly people should be supported in their homes for as long as possible and should not be forced to move away from their family environment. Secondly, the elderly person should be seen as part of the family, community and environment. Thirdly, there is the principle of service provision—comprehensiveness, accessibility, co-ordination, continuity, promptness of intervention and prevention. I should like to think that the Department will take account of those good principles when it finally gets round to responding to Sir Roy Griffiths' interesting report.
The hon. Member for Edgbaston referred to private homes, many of which are old hotels and buildings that have been taken over by private individuals. I do not want to go into all the principles involved, but my basic concern


is that this approach to care for the elderly may result in those homes having staff with no professional training to cater for the needs of the elderly. Catering for the needs of the elderly goes far beyond keeping them dry, warm and fed. It means stimulation, treating them as the individuals they have been all their lives and ensuring that they lead as full a life as possible to the end of their days. I am worried that there is no way of assessing at the point of entry whether individuals receive the correct treatment and no way of monitoring and evaluating the service in them.
I urge the Government to consider the issue carefully and ensure that there are professionally trained people in those homes. If we must have these places, let us ensure that they reach the standards that we would expect for ourselves and our parents. Let us not treat them as "granny farms" but ensure that they genuinely care for the elderly.
These matters highlight some of the problems that face the NHS. I have tried to emphasise that the NHS expects the House to give a clear lead on how funding will develop. I have not heard from Government Members any statement that encourages me to think that the review will be anything other than a cost-cutting exercise. I hope that at the end of the debate we shall hear positive suggestions which will ensure that central funding of the NHS continues in such a way that we can meet the challenges and aspirations presented to us by the people.

Rev. Ian Paisley: We came to the House today to celebrate a birthday. I am sure that those looking in will wonder what sort of birthday party it is. Some hon. Members have denied that they had anything to do with the birth; some want to claim that they had everything to do with it. Some have said they were responsible, others that they were not.
Then there has been the suggestion that we should all go down to the bookmakers and place some bets and, if we win some money, we might be able to clothe and feed the individual who is now 40 years of age. I am sure that as people watch the debate they will realise that we are a close-knit family. Families say wonderful things, make wonderful suggestions and pass wonderful comments.
Although my politics are poles apart from those of the right hon. Member for Blaenau Gwent (Mr. Foot), we are honoured to have with us one who was at the birth. Having been interested in politics for a long time, I have read quite a lot about those days, and I salute and honour the memory of Aneurin Bevan. He was a man who delivered the goods in the end. While there may be much controversy about the how, when and where, there is no doubt that if it had not been for the push, energy and strength of argument that he supplied we would not be celebrating this birth today.
However, when the right hon. Member for Blaenau Gwent chose to quote from one of his own writings he struck a resounding chord in my breast by mentioning the Jesuits.
As an Ulster Member of Parliament, certain matters concern me; and as the only hon. Member representing Ulster who will be able to take part in the debate I want to make the views that I am putting across as broad as possible. I am sorry to see that we are not graced with the

presence of the Parliamentary Under-Secretary of State for Northern Ireland, who is in charge of health and social services there. He was in the Chamber a while ago, but he has now gone. Perhaps he will read my contribution.
The Government amendment states that the Government are
devoting record resources to the Service to enable both hospitals and community services to provide more care than ever before".
I just have to open my eyes to see what is happening to the Health Service in my area. But, first, it is only right that I should pay a warm tribute to all the workers in the Health Service in Northern Ireland, who work through great difficulties. I salute the consultants, doctors, nurses, ancillary workers, ambulance drivers and those who do the cleaning for all that they have done. I know that a small minority during the troubles have not co-operated, and when people who had been seriously wounded by bombs and shootings arrived at hospital they would not even wheel them into the operating theatre. But those were a small percentage. The vast majority merit our support, so I pay this tribute to them.
We have four health boards in Northern Ireland—the Eastern, Southern, Western and Northern. The Northern board covers the area that I and other hon. Members represent in the House. It starts at Antrim and goes right up the coast. It takes in part of Londonderry and stretches into the middle of mid-Ulster. In that area acute hospital services have been located in Coleraine, Ballymoney, Ballymena, mid-Ulster, Larne, Whiteabbey and Dalriada in Ballycastle. Now, under the cuts, all but two of these hospitals are to be axed. No hon. Member could be happy about that.
What are we being offered instead? We are being offered phase 1 of a new hospital at Antrim at the southern extremity of the whole Northern area. It will have only 300 beds. In the northern part of the area there will be an extension to the present Coleraine hospital which, when it is all fixed up, will give us possibly 450 acute beds—for a population of 380,000 people. That concerns the consultants, doctors, nurses, and all who are interested in the well-being of the people of the area. I trust that it will not go ahead.
We have tried in every way to stop the machine that dictates that this must happen. We are trying to get a public inquiry, but it has been refused. The Minister told us that even if the health board disagreed with him he would still go ahead with the scheme, which shows two things. First, there is not enough funding for the Health Service, and, secondly, there is terrible cost ineffectiveness. Phase 1 of the new hospital will cost £37 million, but it will cost £65 million to deal with the road works and all the other servicing of the hospital. Such a sum could be more effectively spent. Some of the people going to the hospital will have to travel, not on motorways, but through pointless winding country roads—27 miles of them in some cases—to get there. That is intolerable to the people of my constituency and of the whole board area.
Another point needs emphasising, too. We need home care for our people. We need the meals on wheels and more home helps. Now they are being cut back to such an extent that people who were able before to have a home help for two or three hours a day are being offered one for half an hour in the morning and half an hour in the evening. That is not good enough for elderly people. Like the hon. Member for Moray (Mrs. Ewing), I am worried about the


new care centres for the elderly, which do not provide proper care or professional nursing staff. The Government need to examine carefully what is happening.
The Health Service is the envy of the world. Everywhere I have travelled in the world people have asked me about it and what is available through it. It is something that we should boast about and sell to the world. It is unique to our United Kingdom and it is worthy of all our support. I hope that we shall hear encouraging things after the debate, and I hope that we will all back the Health Service.

Mr. Robert N. Wareing: I was pleased to hear my right hon. Friend the Member for Blaenau Gwent (Mr. Foot) talking about his experiences in the House when the National Health Service was introduced. I remember as a youngster going along to a meeting on the Sunday before the NHS came into being to hear the late Bessie Braddock talking about the change that was about to take place. The leaflet advertising the meeting was headed "The end of the Poor Law … Come to the funeral of the Poor Law."
The House should be reminded that the introduction of the NHS by Aneurin Bevan was partnered with the introduction of other elements of the welfare state, such as the comprehensive national insurance scheme introduced by Jim Griffiths. With that comprehensive system the Poor Law was ended. What makes people fear for the future of the NHS is that the Government have wrought and are wreaking havoc in the welfare state in many other respects. The social fund is in reality the new Poor Law.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie): Will the hon. Gentleman give way?

Mr. Wareing: I have only just started my speech, but, for the hon. Lady, I will give way.

Mrs. Currie: I am grateful to the hon. Gentleman, who is a fellow Scouse. I am following his speech with the greatest interest. Does he agree that, on this the 40th birthday of the NHS and in a debate of such importance, it is a tragedy that the sum total of Opposition Members now present is two Front Benchers and three Back Benchers?

Mr. Wareing: I assure the Minister that this debate would not be taking place but for the Labour party. For one thing, this is an Opposition day. The Secretary of State would not raise a debate on the NHS at this time. We would not be having the debate at all had it not been for Clement Attlee, Aneurin Bevan and Jim Griffiths, but we shall have more and more debates about the destruction of the welfare state under the Tory Government.
I got hold of a copy of the Conservative research department brief on the National Health Service and read about all the marvellous achievements that are supposed to have taken place under the Government. Some of those achievements, however, are hardly to be applauded. The hon. Member for Wycombe (Mr. Whitney) did not mention that, at a time when the Chancellor is telling us that we have a buoyant economy and have created marvellous wealth for our country, only three other countries in the European Community—Spain, Portugal and Greece—spend a lower percentage of their gross domestic product on health care, and those countries

cannot claim that they have North sea oil. The future of the Health Service depends largely on the strength of the economy, and people fear for it because of our chronic manufacturing trade deficit.

Mr. Alistair Burt: Will the hon. Gentleman give way?

Mr. Wareing: No. The hon. Gentleman must remember that Mr. Deputy Speaker has asked for short speeches. Even if I give way, Mr. Deputy Speaker may deny the hon. Gentleman the chance to make his speech.
The people of this country have a right to be suspicious of the Tory party. I was pleased today to hear the Secretary of State speak along much more "consensus" lines than we remember in the past. Perhaps the Tory party realises how popular the Health Service is in this country, and is moving away from some of the outrageous statements made in the recent past by the extreme Right wing. But the Prime Minister's promise in April 1979 that there would be no increase in prescription charges, and the promise in 1980 that there would be no charges for the eyesight test, do not infuse Opposition Members with confidence that the Government will not return to some of the hare-brained schemes—I believe that the Minister has called some of them batty—that have come from the Adam Smith Institute and other extreme Right-wing think tanks.
According to the Institute's Omega report of 1984,
At present, many of the resources of the health service are spent on people who are quite able to pay their own way … Charging … for non-essential 'hotel' services would seem a reasonable way of asking the more affluent to take up a greater part of the health care burden.
The Tories often say, "We shall exempt those who are poor and in need," but the institute went on to say:
However, the temptation to exempt too many groups will defeat the whole object of the exercise—for example, some 31 million people are entitled to free prescriptions … Food and other items would have to be found by the patient whether in hospital or not, and it seems reasonable that the service should not cover completely free non-medical services and comfort trimmings.
[HON. MEMBERS: "Yes."] I hear Conservative Members saying that they agree with that. That is why the people of this country know that the Health Service is not safe in the hands of the Conservative party.

Mr. Nicholas Bennett: What is wrong with it?

Mr. Wareing: I will tell the hon. Gentleman what is wrong with it. The people are already paying through taxation, based, we hope, on a system that involves the rich paying more than the poor.
The question of food provision in hospitals is a question of providing the right diet as part of patients' treatment. It is revealing that many people say that there are splits among the Opposition. I challenge the Minister for Health, when he comes to reply—he is not here a t present, but I assume that the Parliamentary Under-Secretary is not replying to the debate—to take up the point made by his Back Benchers. Does he agree that there should be charges for food and other so-called "trimmings", as suggested by the Right-wing extremists who now control Conservative Central Office?

Mr. Bennett: rose——

Mr. Wareing: The hon. Gentleman can make his own speech.
The Adam Smith Institute also talks about charging for ambulances, saying:
Non-urgent ambulance journeys can also be charged for".
Even the Minister for Health, quoted in The Guardian on 22 December 1987, said that
it would not be unreasonable to consider charging for food. Meals alone cost about £3 a patient a day … Quite a lot of people feel that it is not unreasonable to at least contemplate whether expenditure on food for people who are in hospital and not at home should be taken into account".
Interestingly, Dr. Maureen Dixon, director of the Institute of Health Service Management, said that that was facile, and the British Medical Association also pooh-poohed the idea. [HON. MEMBERS: "Hear, hear."] It does not surprise me to hear Tory Members saying, "Hear, hear." A London Weekend Television poll found that
nearly two thirds of Tory MPs are worried about the NHS",
but the poll, carried out by the Harris Research Centre, showed that
63 per cent. of the 135 Tories questioned … believed that NHS patients should pay bed-and-board charges for staying in hospital. Moreover, 56 per cent. favoured a charge for visits to family doctors, with exemptions for the old and needy. Sixty five per cent. wanted tax concessions for private health insurance.
We are not out of the wood yet, because there is the danger that, following the review, the Government will go for private health insurance and will give firms incentives to provide insurance for their employees. Aneurin Bevan put succinctly the argument against any industrial basis for a private insurance scheme. In "In Place of Fear", he said of such schemes:
they are no substitute for a national scheme. An industrial basis is too narrow for the wide range of medical needs which should be met, both for the worker and for his family.
He referred to the experience under the old approved societies. Such a system would mean two types of health insurance provision—that in the expanding industries and that in declining industries.
Under the present regime, we are moving rapidly towards an increasing involvement of the private sector in health provision. It is an unplanned expansion and there is no co-operation between the public and private sectors. More and more private nursing homes are blossoming, and they are being created without any thought of the need to plan properly. In the Mersey region, in two of the hospital areas—Chester and Fazakerley in Liverpool—private nursing homes are being opened. No doubt they will make profits for health care firms, but there will be no real concern for monitoring the provision of these services. In south-central Liverpool, 2,500 elderly people are in private nursing homes, but at what cost to the DHSS?
The NHS has to service these homes, and local doctors have to treat people in them. However, the family practitioner committees have no part in the planning or monitoring of the services provided by these homes. There is no formal complaints procedure and the community health councils have no say in the workings of these private nursing homes. The health authorities do not have the manpower to monitor whether they provide proper catering and accommodation and whether the medical treatment required by elderly patients, such as physiotherapy, is being provided.
I hope that the Minister for Health will look at the issue of proper funding of the ancillary services in hospitals. So

far, he has set his face against agreeing that the recommendations of the review bodies on the pay for health staffs will be fully funded by the Government. If they are not, there will be a continuation of the strains on nurses in hospitals. In its report, the Select Committee says that it was told by the Royal College of Nursing that studies in two areas—St. Thomas' hospital in London, and Southampton—showed that nurses spent 40 per cent. of their time on non-nursing duties such as taking patients to and from departments, collecting medical notes, collecting incontinence pads and doing the sort of work that other helpers should be doing. Although it is important, pay is not the only reason for the difficulty in recruiting nurses. A bigger problem is the burden on nurses who have to work long hours, often dealing with difficult patients and doing other people's work.
The low pay of ancillary staffs and all those who are part of the collective health team upon which the treatment of the patient depends should be greatly improved. Over 30 per cent. of the wages bill of the NHS goes on ancillary staff, so it is incumbent on any Government who believe in maintaining standards in the NHS to fund that improvement in full. I hope that the Minister will say something about this.
It is difficult for people with the sort of philosophy that is dominant in the present-day Tory party to consider what is needed in the fight against disease and to help those who are suffering. That involves the philosophy and values not of the yuppie mentality, the "Ioadsamoney" mentality, or the stock exchange, but of something much higher in humanity, which fills those of us who believe in the NHS. I know that, in the words of Aneurin Bevan——

Mr. Forth: Not again.

Mr. Wareing: Yes, again. In his "In Place of Fear" he spoke about
the massive contribution the British Health Service makes to the equipment of a civilised society. It has now become a part of the texture of our national life. No political party would survive that tried to destroy it.
That truth may be getting home to the Secretary of State. I hope that, no matter what other destruction is wrought on this country by the most evil Government that we have had this century, they have learnt the lesson from popular opinion that they dare not destroy Britain's Health Service.

Mr. Roger Sims: It is a pity that the hon. Member for Liverpool, West Derby (Mr. Wareing), having obtained a copy of the Conservative party briefing for this debate, did not read it. Had he done so and contributed to the debate from it, he would have made a rather more constructive speech than the extremely unhelpful and in many respects inaccurate one that he made.
The 40 years of the NHS is a cause for celebration. We have a good story to tell. A debate in the House is the opportunity to tell it and to look to the future. That is exactly what my right hon. Friend the Secretary of State did in an effective and wide-ranging speech. What have we heard from the Opposition? Over the weekend we heard the Leader of the Opposition, and today we heard from the Opposition Front Bench spokesman, the hon. Member for Livingston (Mr. Cook) and the hon. Member for West


Derby, each of them with a catalogue of gloom, doom and criticism. Have we heard one word of constructive comment from them?

Ms. Hilary Armstrong: The hon. Gentleman did not hear the speech of my hon. Friend the Member for Birkenhead (Mr. Field).

Mr. Sims: I shall refer to the hon. Member for Birkenhead (Mr. Field) in a moment.
One wonders whether some Opposition Members have read the Health Service report for 1986–87 and absorbed some of the facts and figures in it. It shows that there has been increased expenditure on hospitals and family practitioner services and that £960 million has gone on capital expenditure. Have the Opposition seen the figures of additional funds released by the sale of surplus land and of cost improvements that have released cash for patient care? Do they not accept that we are now spending £45 million a day on the NHS? It is treating more patients than ever before. There are more doctors, dentists and nurses, and they are better paid. The facts are completely different from the picture that the Opposition seek to draw.
After 40 years, this is a good time to consider the structure, funding and functions of the National Health Service. Many changes have taken place in those 40 years. My hon. Friend the Member for Eastleigh (Sir D. Price) referred to the change in the age composition of the population. There have been enormous changes in the treatment and the methods available. Sophisticated and expensive drugs and surgical techniques that were undreamt of 40 years ago have become available in the past few years.
It is right that the Government should be reviewing the structure, functions and funding of the Health Service. It is also right that the Social Services Select Committee, of which I am a member, should be reviewing it. Is the Labour party reviewing the National Health Service? We look in vain for any new ideas. We have heard none today and there are certainly none in the motion. As is so often the case, it is the Conservatives who are progressive and who are putting forward the new ideas. It is the Labour party that remains conservative. Its only policies are to oppose any new ideas, and simply to demand more money.
I agree that more expenditure is needed, and we have said as much in the Social Services Select Committee. I shall not argue with the Minister for Health or the Secretary of State about how much that should be or how it should be calculated. However, I notice that, although the Secretary of State sometimes disputes the Select Committee's conclusions, he has occasionally made extra funds available. I should like to think that our conclusions are having some influence on him. I certainly argue that the extra funds should be for specific purposes. We will not solve the problems of the Health Service by simply throwing money at it.
I should like briefly to examine four areas. One is information technology to which the hon. Member for Birkenhead referred. The House will have realised how fortunate we are in having the hon. Gentleman as Chairman of our Social Services Select Committee after his well argued and reasoned speech. His was the exception to what I have said hitherto about Opposition Members' speeches. Information technology is now widespread in

industry and commerce. The National Health Service is a huge undertaking, yet it is way behind in its use of information technology. It will have to catch up.
I welcome the plans to introduce the family practitioner service's data communications network that will enable GPs to communicate with each other and have access to National Health Service data. I welcome, too, the introduction of resource management trials in various hospitals. They will enable consultants and managers to know the cost of operations and treatment—something that they do not know at the moment. They will give managers the tools of cost control and will also make practicable the operation of the internal market. They will also streamline the way in which consultants can handle patients. For example, they will be able to arrange a series of tests of a patient in one step, simply by pressing a button or two, instead of spending time completing a whole series of forms.
Resource management will benefit the patient and lead to more efficient use of the skilled manpower in the service, but it will be expensive. In one health authority that the Select Committee visited, we were given a figure of £3 million to £4 million. That expenditure will, of necessity, be phased and it must in the long run be to the benefit of the National Health Service and all its users.
Secondly, we must make greater use of the private sector. We have seen examples today of the Opposition's Pavlovian reaction to any reference to the private sector, although it is interesting that many members of the Labour party are happy to use the private sector, and, of course, some 40,000 trade union members are covered by private health insurance.
The Labour party is fond of referring to the proportions of GDP that are spent on health expenditure. It is interesting that, as a country, we spend rather less on health care as a proportion of the GDP than do many others. We should encourage more people, who can afford it, to spend more of their money on private health.
There is ample scope for more co-operation between the private sector and the National Health Service in both directions. There are many examples of where the National Health Service has contracted out to the private sector for operations, such as hip replacement. Similarly, the private sector is using the National Health facilities on a cash basis, obviously to the advantage of the NHS. The problem is that in many parts of the country local political views and political appointees on the health authorities prevent that co-operation from developing.
Thirdly, the pay increases to the nurses have been widely welcomed. We must now study the problem of the ancillaries' pay. For example, I have in mind the MLSOs and medical secretaries, who perform a vital role. Many consultants rely simply on women who produce their notes out of a sense of personal loyalty and dedication to the service—certainly not for the money they receive. They could do far better by going down the road and working in the commercial sector.
I would like to take this opportunity to draw particular attention to the profusionists. Hon. Members may not be familiar with them. There are only 140 in the country. In laymen's terms, their job is to attend to the equipment used for pumping blood around the body during heart surgery. I suppose that, if one has to define them, they are a cross between clinical technicians arid anaesthetists. They form an integral part of a theatre operating team and without them heart surgery would stop, yet they are on the PTBE


grade—the lowest grade. A top profusionist earns half the salary of a top radiologist. Like other ancillaries, they are vital to the NHS, and it is important that we should consider their case. I am sorry that the Secretary of State did not feel able to meet a deputation from the profusionists. I hope that after my remarks he will be prepared to reconsider that.
The fourth area is that of preventive medicine. It could be the subject of a speech in itself, but I simply confine myself to welcoming the documents recently produced by the Health Education Authority and its efforts to promote the "look after your heart" campaign.
As chairman of the parliamentary ASH group, I draw attention to the largest avoidable cause of disease and death—smoking. I pay tribute to the work of ASH in trying to promote its cause. I suggest that a modest increase in funds to both those bodies would reduce the demands on the National Health Service, whose 40 years of success we are pleased to celebrate today.

Mr. William O'Brien: I am pleased to take part in this debate. We are celebrating the 40th anniversary of the Health Service. We must express our appreciation for the work that people in the Health Service do on behalf of patients.
The hon. Member for Chislehurst (Mr. Sims) referred to the Secretary of State's speech and the value of private medicine. I suggest that the right hon. Gentleman is blinkered. He mentioned the history of the service but had to have his attention drawn to the fact that he had not mentioned its architect. Only after provocation did the right hon. Gentleman accept that he had made an error in not referring to Aneurin Bevan.
The hon. Member for Chislehurst is effectively saying that if a person is wealthy he can afford to buy health. My constituency covers three health authority areas, one of which, Wakefield, is going through a traumatic period—and it has been since we had the salmonella poisoning outbreak at Stanley Royd hospital. The oubreak arose as a result of inadequate funding with which to provide a proper kitchen for hospital meals. Nothing has changed very much.
I invite Conservative Members to come and see what is happening in my constituency. They would see how the health authority has been starved of the resources necessary to provide the patient care that everyone screams we should have. If Conservative Members are sincere, I suggest that they visit Wakefield.
On 16 June, I received a letter from the Minister for Health. It was a copy of a letter that he had sent to the chairman of the health authority. I wrote to the Minister asking to meet him because of what he did not say in that letter, but the meeting has not been arranged. It appears that the Minister is afraid to discuss what is happening with Wakefield health authority because of what would be revealed. It would become clear that what the Secretary of State said today is a pack of lies and that nobody can believe what the Tories say about defending the Health Service. What is happening in Wakefield should be revealed.
We asked for an independent inquiry into the area's management, but it has been refused by the Minister. An

inquiry is being carried out, but by the regional health authority. That cannot be fair or reasonable because of the authority's interest in the matter. There will be tremendous rancour in my area when the report is published because it is clear that the inquiry's findings will not be in the best interests of the area. There will be tremendous shortfalls in its recommendations.
On the evening of Sunday 26 June, in the cardiac ward at Pinderfield hospital, all the patients were aroused because staff came in saying that they wanted more accommodation. People had to be moved—at 11 pm on a Sunday. The health authority is being reduced to that because it is not being allowed sufficient resources. Unfortunately, a patient died that evening.
A constituent who had suffered a couple of heart attacks suffered another over the Christmas period and was refused admission. That person died shortly afterwards. Imagine how distraught a person's wife and family are when he needs help but cannot receive it. People cannot receive help because the health authority has had to cut the number of beds in the unit to meet budget proposals. That is the kind of Health Service that Conservative Members say they support. Heaven help us if that is how the future develops.
We are told that resources necessary to meet requirements are now available and that people who can afford to go private ought to do so. A constituent came to see me on Saturday. She has wanted treatment and hospital care for some time. In a statement she sent to me she says:
It was the first week in December 1987. My leg had deteriorated rapidly and there was a distinct shortening. Dr. Gaunt gave me no choice of consultants saying only that she would ask Mr. Ghali to see me as he had a very short waiting list and I would be seen before Christmas … She told me I could have physiotherapy on the NHS. I would also be fitted with a heel lift for my rapidly shortening limb. I was grateful for this as I live on a very narrow income with little stretchability to include private treatment of any sort. Alas, that promise was unfulfilled. Towards the end of January I received an appointment to see Mr. Ghali in June!!! I rang his secretary thinking there must be some mistake; I was told that had Dr. Gaunt put 'URGENT' on the request I would have been seen much earlier. Back to Dr. Gaunt … She refused to request an urgent appointment and said the only way I could be seen earlier was by seeing Mr. Ghali privately at Methley Park. I again pointed out the limitations of my income and also my principles which baulked at private treatment. However she refused to enter into any more conversation and unhappily I had to agree to the private consultation. An appointment was then obtained within 48 hours.
The House should remember that she was given an appointment for June in January. The statement continues:
I had a 20 minute consultation with Mr. Ghali and within a couple of days had received his account for £50, he had my cheque by the weekend … He assured me that I was now on the waiting list. I asked whether it would be possible to be transferred to another health authority with a shorter waiting list. I was prepared to go anywhere in the country. Mr. Ghali replied he has the shortest waiting list in the land—from 6–9 months. My leg was then 1½" shorter. Mr. Ghali promised me a heel lift and physiotherapy in the meantime.
We have heard today that that can be done.
My leg now began to deteriorate rapidly, the shortage increasing to 2" at which point I had a heel lift fitted privately, within two weeks I could no longer put my foot to the ground again and the shortening had increased to 3" … I wrote to Mr. Ghali now fearing that my limbs would not be brought into alignment. By this time, it was April and I had previously seen Mr. Ghali in February at Pinderfield under the NHS. He reassured me that my place was safely on the waiting list and again promised a heel lift and physiotherapy … these


promises never took place—hence—my own purchasing of heel lift. Mr. Ghali failed to reply to my letter but within 10 days of my writing him I had an application form from Mercantile Credit for a financial loan, this came unsolicited by mail; one of the 'benefits' outlined was that of private surgery … In my letter to Mr. Ghali, I had included the sentence: 'I do not have the financial resources to seek private treatment"'.
That is the kind of situation that is developing. Patients who admit that they do not have the money to buy private medicine are being canvassed by moneylenders to mortgage their future so that they can have private medical care.
That is Thatcher's Britain of 1988. The Secretary of State buries his head in the political sand. I challenge the Secretary of State, the Minister for Health and the Under-Secretary of State to come to my area. I will introduce them to case after case similar to the one to which I have just referred. When Conservative Members tell me how they see the Health Service, I tell them that they are blinkered and indoctrinated with Tory philosophy. My constituents will receive treatment only if there is an end to Tory doctrine. That is the only way to make the Health Service free at the point of need. Until the Government do that, the Health Service will not be run satisfactorily.
I add my plea to those of my colleagues and of the leader of my party for additional resources. The £2 billion requested last year should be channelled into the Health Service. We had a windfall last year and certain moneys were allocated to the regions. The sum of £4·5 million was allocated to the Yorkshire region. The £230,000 allocated to the Wakefield district health authority was channelled into the cook-chill system, which has caused so much antagonism in my area. The money did not go to patient care. It went to meet the shortfall of a system that is being introduced against the wishes and interests of patients in that area. The money was spent on an idea put forward by the district manager that we should have a cook-chill system in hospitals rather than traditional meals.
Conservative Members should wake up and realise that what is happening in the Health Service is not the rose-coloured development to which the Secretary of State refers. The real world is what the patients are having to suffer. If Conservative Members do not believe that that is the case, I invite them to come to my constituency and witness for themselves what we are having to go through.

Mr. John Maples: The hon. Member for Normanton (Mr. O'Brien) has given us an impassioned and obviously heartfelt criticism of what is wrong with the Health Service. However, in common with the speeches of all his other hon. Friends, except the hon. Member for Birkenhead (Mr. Field), his speech failed to contribute anything new to what might be done about the problems of the Health Service. In such a debate, on the 40th anniversary of the Health Service, when a deep and serious review by the Government is under way, one would have thought that we could have looked to the Opposition for some constructive thoughts and ideas. We do not expect that from the Leader of the Opposition. I do not think that he is given to deep thought on that or other matters.

Ms. Hilary Armstrong: You got it on Sunday.

Mr. Maples: We expect the catchphrases and shallow polemics that we heard on Sunday. The hon. Lady will get a chance to make her speech in a moment.
The hon. Member for Livingston (Mr. Cook) is one of the intellectual heavyweights in the shadow Cabinet and we might have expected something a little more constructive and heavyweight from him, instead of which we had his usual witty and eloquent speech poking fun at the Government's review. We heard nothing new or constructive. He appeared to echo what now seems to be Labour party policy on the NHS, that the Government should have spent the £2 billion used in tax cuts on the NHS. Hon. Members may believe that, but, if we had a Labour Government, we would not have the £2 billion. That has come from the fact that the economy has grown for the past eight years whereas, with a Labour Government, it would not have done so.
We had some lecturing on history, not least from the right hon. Member for Blaenau Gwent (Mr. Foot), who took us on a nostalgic tour of the late 1940s. Although he describes that period eloquently, I do not believe that he has ever moved out of it. With all the talk about Aneurin Bevan, the 1940s and what the Labour party did to fund the National Health Service, one wonders whether the period from 1974 to 1979 existed. In the rewriting of the history of Socialism, have the Labour Governments of Harold Wilson and Jim Callaghan been obliterated?
Conservative Members take it ill from Opposition Members when they criticise us about underfunding. When the Labour party was responsible for those matters in Government, it cut spending in the Health Service and completely halted the hospital building programme. Lectures from Opposition Members on those matters come very ill and appear extremely hypocritical.
There is no doubt that, whatever is wrong with the Health Service, in the past five years, more doctors and nurses have treated more patients more efficiently than ever before. One may ask oneself how that fact compares with the fact that beds are being closed and the public and many doctors are unhappy about what is happening in the Health Service. I want to make a constructive suggestion about one of the things that the Government might do in their review. The causes of what is going on are a combination of medical advances, an aging population and, quite correctly, higher expectations of people about what the Health Service might deliver to them. The Opposition pretend that it is simply a question of money, but that is not true. In real terms, the Governnent are spending £5 billion more than was being spent in 1979, yet some problems still remain. The idea that another £2 billion or £3 billion will solve that problem is simply incredible.
Potential demand is being fulfilled, but we need some form of rationing, by queue, price or regulation. In the Health Service, we have it by queue and in the private sector we have it by price. I prefer queues to prices in that connection. My right hon. Friends the Prime Minister and the Secretary of State are right at this point to conduct a serious review and I hope that they are considering the objectives of the Health Service. Those are crucial. We must decide what we are trying to do and what we cannot do with the Health. Service and its funding. However. the structure of the NHS is the most important point to which I wish to address my remarks. There is no point in deciding


whether we should spend any more money before we have decided whether we have the right structure in place for delivering the service.
I and all my hon. Friends remain thoroughly and wholeheartedly committed to the Health Service, but that does not mean that it must be delivered in the form in which it is presently delivered. I wish to make a plea to my hon. Friend the Minister and to my right hon. Friend the Secretary of State for a move towards the establishment of an internal market. That would get us around some of the difficulties over the present administration of the Health Service which is necessarily bureaucratic and monolithic. There is little or no consumer choice and no competition in pursuit of efficiency. That question of efficiency is crucial to how much money we should spend.
Considerable advances have been made in management, with doctors becoming involved in the costs and choices that face them, but various matters raise considerable doubts in one's mind. For example, bed occupancy varies from 70 per cent. to 90 per cent. between district health authorities. The average length of stay varies from three and a half to 11 days. The recent National Audit Office study of the use of operating theatres came to the amazing conclusion that the average daytime weekly theatre usage is probably in the range of 50 to 60 per cent. We are told that the United States has a substantial overprovision of health services in many areas because of doctors' incentives to sell them, yet they manage to get by on six hospital beds per thousand people, whereas we have eight.
The performance indicators produced recently by the DHSS are perhaps not as reliable as we should like them to be, but I should like to take three of them which illustrate my point that there are enormous discrepancies of cost in different health authorities. If we take the cost per case as a percentage of the average, after having been adjusted for case mix and mobility, in the South-East Thames region there are variations between Camberwell in south-east Kent, at 3 per cent. below the national average, to Dartford and Gravesham, which is 115 per cent. above. That is a 20 per cent. variation in one region and there are similar variations between health authorities across the country.
The cost of providing the hotel service on a per bed, per year basis, varies among regions. In East Anglia, it is just over £1,000 and in north-east Thames it is just over £1,700. That is a variation of 66 per cent. Within the South East Thames region, the lowest is Maidstone with £895. The highest is a health authority which is well known to the hon. Member for Peckham (Ms. Harman) and myself, with £4,487. That is a factor of five. How can it cost five times as much in one authority as it does in another? The statistics to which I have already referred show that the highest costs are not always to be found in inner London. Camberwell is one of the cheapest areas on the basis of cost per case. There must be something radically wrong if one authority can do something for a fifth of the price of another.
I shall take one more example, and that is expenditure on linen, or laundry. There is a variation from £6·50 in Oxford to £10·90 in the South West Thames region. That is a variation of 67 per cent. Within the South East Thames region, the most expensive area is Eastbourne, with £14·80.

The cheapest area is Hastings, which is next door, with £4·40. How can it cost three and a half times as much to provide a linen service for a hospital in Eastbourne as it does in Hastings? I suggest that these massive discrepancies should make us ask ourselves whether services are being provided as efficiently as possible.

Mrs. Alice Mahon: Will the hon. Gentleman give way?

Mr. Maples: No. I am sure that the hon. Lady will have the opportunity to make her speech. I wish to be brief.
There are no clinical unit costs available. It would be interesting to know the cost of a hip replacement in one area compared with the cost in another. Those are figures towards which an internal market must work. The old DHSS performance indicators, which were issued in 1982, contained such figures. The cost of a maternity case varied throughout the country from £215 to £690. It would seem that the discrepancies in unit costs are repeated in clinical areas as well. We cannot escape the conclusion that if the best practice were followed, or if the 20 per cent. best practice were followed across the country, we would obtain much more health care for the money that we are spending. That is why I suggest to my hon. Friend the Under-Secretary of State that we move towards introducing an internal market. It would expose cost discrepancies, and competition between the providers of care within the market would encourage best practice. We would have smaller management units. The Health Service is enormous, and the British are terrible at running large organisations. I believe that smaller units would be much better run.
A free service does not necessarily have to be provided by the state. I believe passionately that we should have a free Health Service, but it does not have to be provided by the state. The private sector virtues of competition and the promotion of choice and efficiency can be introduced within a free state service, and that is being done in education. The purpose of some of the reforms that we are introducing in education is to promote diversity, choice and efficiency. That can be done within the Health Service too, while it remains a free service.
In the internal market that I have in mind, the money would follow the patient. The job of district health authorities would be to buy health care, in some instances from public hospitals and in others from private hospitals and charitable hospitals. National Health Service hospitals would become free-standing institutions competing for patients. The district health authority would be able to compare costs and negotiate the costs of what it would obtain from the various hospitals. It could obtain the combination of the best service that it wanted at the lowest price. That is not open to an authority now when budgeting is done on a block basis. I believe that choice would develop as hospitals specialised. The costly duplication that we see now would be eliminated, or at least reduced.
To some extent, that is happening already. It is not a revolutionary idea. I should like to pretend that it is and that I thought of it, but it is not. The NHS buys all its drugs and supplies in the private sector. We do not feel that it is necessary for the NHS to produce those items. Many of the fees for private nursing home treatment for what would otherwise be NHS patients are paid by the DHSS. In Guy's hospital, which is in the district that


contains my constituency and that of the hon. Member for Peckham, the private wing never made any money and caused many problems. The management of these wings was handed over to a private hospital, which is now making some money from it. The two hospitals buy and sell services from and to each other. Pathology and X-ray services are sold to the operators of the private wing. It is an arrangement which helps both hospitals. There are many examples of district hospitals buying and selling services to and from one another and from the private sector. In 1985, the last year for which I have figures, 28,000 NHS patients were treated in private hospitals.
One of the most interesting examples is the establishment in Wales of a renal dialysis unit, which was put out to tender to a private company. Tenders were invited on a cost per case basis and the unit cost was reduced from £120 to £80. The unit was built and was running in six months. Any of us who are trying to secure capital improvements for our local district hospitals through the region and the Department know that that process has to be measured in years rather than months.
The practices which I have described should be extended further. The district health authorities should be used as the engines for developing an internal market. This is not something that can be introduced in the form of a big bang, but it should be allowed to grow. It is crucial that district health authorities should be told in their budgeting that they are not to give a block grant of £30 million to one hospital and £22 million to another. Instead, they should be instructed to buy costed and budgeted items of service from the units that are providing the services. The creation of an internal market in health care would promote efficiency and choice, which we all want to see. It would be more likely than the present system to provide patients with what they want. It should deliver more health care for the same amount of money. There would still be rationing and there would be difficult choices to make, but at least we would know that money was being spent to the maximum effect.

Rev. Martin Smyth: I welcome the opportunity of participating in the debate. The day began for me by watching the Under-Secretary of State on television. Like me, the hon. Lady was a member of the previous Select Committee on Social Services, and she criticised the present Committee because it is looking for more money. I assure her and the House that the Select Committee is like its predecessor in that it is determined to examine the issues and report accordingly. If we request more money, it is because the evidence thus far shows that that money is needed.
As I said yesterday during the press conference, the Committee's first report was criticised for producing an arbitrary figure that was plucked out of the air. Since that figure was published, we have discovered that the Minister has graciously pumped quite substantial sums into the Health Service. I said at the press conference that I do not mind what words are used by the Secretary of State as long as his actions speak louder than those words.
As we pay tribute to 40 years of the National Health Service, it is not amiss for any of us to examine in detail what is going on. I have no hesitation in saying on behalf of the people of Northern Ireland that we know the benefits of the Health Service. For 18 years before

becoming an hon. Member I ministered in the congregation of which the first Minister of Health under the Health Service, the late William Grant, was a member. He was a Labour Unionist who was concerned to find the best services for the people at the best rates.
During my life I have seen tremendous changes from the days when I was a patient in the old fever hospital. It stood on the City hospital site, where there is now a magnificent tower block to serve the people of south Belfast. I pay tribute to the work that has been done. However, in the NHS, as in Parliament, the Church and every part of society, there will be excellent workers arid the mediocre. There will be dedicated nurses and others who will be looking for Mrs. Brown every half hour of the day. For those who do not know what Mrs. Brown is, may I say that it is a code term for a cup of tea. We pay tribute to what has been achieved but we recognise the disparities that arise.
It is not enough to look back nostalgically and to think of the past as being wonderful because, in my judgment, there was from the very beginning an arbitrary figure snatched from the air for the service's funding, and we have never fully recovered from that.
Accordingly, if I may follow the hon. Member for Lewisham, West (Mr. Maples), the recommendation to which the hon. Member for Eastleigh (Sir D. Price) referred in his reasoned address pinpointed one of the Health Service's great needs, which is for better information technology. Anyone who imagines that the Select Committee was being unreasonable in suggesting that it would take another £1·8 billion to meet the Health Service's current pattern and improve it should remember that subsequent evidence has confirmed that reasoning.
It is exceedingly difficult to know the state of progress in every district, because some districts do not know what state they are in. In addition, judging by some of the answers I receive from the Department in Northern Ireland, which is much smaller than the equivalent Department in England, it also does not know the answers to all the questions. We are told that the best parliamentary question is the one to which one knows the answer before asking it, because time and again we discover that the Departments do not have the answers.
If there is to be an internal market, the district authorities must be supplied with the right tools. Only then will they be able accurately to price their services. I speak from experience. Even in a small community such as we have in Northern Ireland, the services provided by the Eastern board to the Western board are often discounted, because that is easier than going through all the paperwork that is needed to make a charge for them. When we speak of an internal market, we must also bear in mind that aspect.
Reference has been made to variations in the costs of providing linen and other laundry services, but we need more information before reaching an objective conclusion about the reason for such differences. It may be because of privatisation. In the previous Select Committee, we discovered that under privatisation someone had overlooked that redundancy payments might be necessary, and a figure of £15 million was ultimately suggested to us as being the sum required. We also discovered that some people employed in cleaning and laundry services in one district health authority had moved to another without receiving a redundancy payment. When making decisions, we must be careful to consider their consequences.
While we have remarkably good services in Northern Ireland, to which I must pay tribute, they are under pressure. This year, the Eastern board is looking for £7 million out of savings to meet current expenditure, but that will be impossible to achieve without making any cutbacks. The Minister responsible for the Health Service in Northern Ireland said that its health care budget is proportionately about 25 per cent. greater than in England and Wales. However, that must be put in its proper context. No more than three months ago I had the privilege of being treated as a National Health Service patient in the Royal Victoria hospital, which not only has the problem of high numbers of clamouring patients but the tragic security situation and the extra expense that it entails.
For example, I had to be accommodated in a secure unit. As a result of terrorist activity, there has been a tremendous technical advance in treatment, which is undoubtedly one reason why the Eastern board incurs nursing charges for north-west Belfast, in the Royal group of hospitals, that are much higher than for others. They provide intensive nursing treatment. In that context, it is tragic that in the years 1985–86 and 1986–87 there has been a reduction in real terms of about 4·1 per cent. in the budget. If we are to continue making proper provision at the point of need, we dare not curtail those services.

Mr. Simon Burns: I am grateful for the opportunity to participate in today's important debate, but I hope that the hon. Member for Belfast, South (Rev. Martin Smyth) will forgive me if I do not follow his remarks. I am also sorry to see that the hon. Member for Southport (Mr. Fearn) is not in his place—I see that he is just entering the Chamber. I was mesmerised as he tripped the light fantastic around the SLD's health policies. Last year, I fought a Liberal candidate and thought that I had some view of what the alliance's policies were. However, the swerves and U-turns made this evening have confused and bewildered me. I suspect that that is symptomatic of the SLD as a whole, and that none of my hon. Friends has been enlightened as to its health policy.
The Opposition are to be congratulated on initiating a debate on the 40th anniversary of the National Health Service, as it is singularly appropriate today. I join in agreeing with that part of the motion congratulating present and past staff of the National Health Service on their tireless and unstinting work on behalf of the sick and the elderly. Their dedication and devotion to duty shines as an example we must all seek to emulate.
It was probably Miss Elizabeth Taylor who claimed that life began at 40, but that was not true for the National Health Service. Life began at its birth 40 years ago, and in every year since 1948 it has met the challenges and has improved. It has gone from strength to strength, so that it now provides a wider range of services and health care, meeting the challenges of changes in medical science and technology that were not foreseen or envisaged when Beveridge and Bevan dreamt up and then enacted the National Health Service in the late 1940s.
I unstintingly support the National Health Service and use it exclusively—or inclusively—for my own health care, because I have found that it is excellent in the services that

it provides. I have found also that my constituents, who are blessed with two excellent hospitals in the area, are confused and angered by the Opposition's constant attacks and carping purely for political gain.
However, I cannot agree with the majority of the sentiments expressed in the Opposition's motion today. It is not in the interests of the NHS merely to throw money at it willy-nilly. That might result in short-term political gain, or even reach tomorrow's newspaper headlines, but it does not go the heart of the problems that people claim exist in the NHS.
Given the record £23·5 billion that is spent on the Health Service each year, we should consider whether it is as efficient as it should be. I cannot believe that with such a large budget its efficiency is as good as it should be in areas such as drugs, energy and the managing of the hospitals and the consultants. I pay tribute to my hon. Friend the Member for Wokingham (Mr. Redwood), who has produced figures on the effectiveness and efficiency of NHS staff.
If more and more money is thrown at the Health Service without looking at what happens to that money, people will, as in "Oliver Twist", constantly be coming back for more and more without ever tackling any fundamental problems. That is why the Opposition's motion is so depressingly negative. It offers nothing new or positive and, ultimately, nothing realistic for the Health Service's needs in the next 40 years.
Let me deal now with some of the figures that illustrate the wide variations in the service that is being provided in district health authorities which suggest to me that something is wrong with the efficiency of the Health Service and need to be looked at.
One of the greatest complaints, as has been mentioned, is about waiting lists. It is extraordinary that the Health Service does not know the correct figures for waiting lists. They may ay be up to 20 per cent. wrong because people either do not bother to turn up for appointments or they move to another district health authority without informing their previous health authority so that they remain on its waiting list, at the same time joining the waiting list in their new area. That exaggerates the figures and builds up the waiting lists. It is odd that the Health Service cannot even get that right. A private business with little control over, to put it crudely, its stock would be in serious trouble fairly quickly.
The waiting lists remain longer than they should be because there is too little interaction between hospitals and health authorities which may be able to swap and inter-marry their services. One health authority may have a long waiting list for one type of treatment but not for another of which another authority could make use. There could be greater inter-marriage between health authorities and between the NHS and the private sector. The Health Service could use its power as a bulk purchaser to buy services from a private hospital that might not be particularly busy at a given time.
The cost variations throughout the country of different services are a national scandal and should be looked at closely. The number of ancillary staff needed per 1,000 in-patients in Milton Keynes is 5·7 whereas in Halton it is 41·3. The number of administrative and clerical staff per 1,000 in-patients in Scarborough is 8·6 while in Halton it is 46·7. The number of nursing and medical staff per 1,000 in-patients in Scarborough is 39·4 while in Halton it is 160·9. The cost per case for medical records at the West


Cheshire hospital is £24 per patient. At the Charing Cross hospital in Hammersmith it is £124. The cost of drugs per patient in Scarborough health authority is £21·50 per patient on average, while in Hampstead it is £153·50 per patient.
Clearly those figures highlight the need for improvements and for cost savings so that the money saved can be targeted towards other parts of the Health Service that need funds to expand their services to meet greater demand without any reduction in health care. That is what we should be looking at, and I am sure that the Department of Health and Social Security, under my right hon. Friend the Secretary of State for Social Services, is doing that.
There are other ways in which savings can be made without any adverse effect on health care, and I trust that the review is considering them. I should like to mention additional funding for the Health Service. I am not talking about the money that the Government provide year in, year out. I mean genuine additional funds from outside the NHS. I believe that a single National Health Service lottery should be introduced to harness the goodwill and the energy of people who already raise money to buy a kidney machine or a CAT scan. Once the scheme is up and running, and as long as the Treasury keeps its paws away from it, in the fourth year of a properly run lottery £1 billion extra could be raised to be spent on equipment that people can identify with. I see nothing wrong with that, and I urge my right hon. Friend to consider it seriously.
The Government have just enacted the Local Government Finance Bill introducing a community charge for financing local government so that every individual knows what local government is costing. I believe that a similar charge should be introduced for the National Health Service. Few people have a clue as to how much they are paying from their taxation. Few people know that the average family pays £32 per week towards the cost of the Health Service compared with £11 in 1979. The average family's weekly contribution has increased by £21, and that shows our commitment to the Health Service. We must bring home to people the cost of the Health Service so that they can decide how they want their money to be spent, and whether they want more money to go to the Health Service rather than to other services. This matter deserves serious consideration.
I shall support the Government's amendment because fundamentally it is more constructive in considering the Health Service than the Opposition motion. I look forward to the announcement of the review that my right hon. Friend the Prime Minister has instigated and is expected to take place later this year. I hope that it produces constructive ways of tackling any unease felt by Opposition Members about the Health Service.

Mrs. Gillian Shephard: I shall be very brief. Many statistics and case histories have been bandied about during the debate, and I certainly do not intend to repeat them. But I cannot resist reminding the Opposition, since it was their choice of debate, that more is being spent on the Health Service than ever before, more patients are being treated, more professionals are being employed and there are more areas in which this country is leading its counterparts in terms of research and medical

performance. All that is accompanied by the largest-ever hospital building programme in the 40-year history of the National Health Service.
I wish that the hon. Member for Wakefield (Mr. Hinchliffe) was present because he offered a challenge to all hon. Members to visit his constituency and see what he described as the crumbling Health Service. I should like to invite him, or any other Opposition Members, to visit my constituency to see the investment of £31 million in the West Norfolk and Wisbech health authority in the past nine years in capital building and the doubling of funds to run the Health Service for my fortunate constituents in south-west Norfolk where the terms "crumbling" and "crisis" would be curiously misapplied.
On the 40th birthday of the NHS what is more important than lists of achievements and of what is being spent is the rather more sophisticated debate about what we want from our Health Service in the next 40 years, how we can measure its success or otherwise, how we can best use the skills of those working in it and how we can achieve those objectives. One positive outcome of the debate that raged around our Health Service throughout the autumn and the winter, and which is mirrored in other western democracies, has been the plethora of ideas about new development and different ways forward. There has been a public realisation that, although there is general satisfaction with the performance of the NHS—we know that 90 per cent. of people are satisfied with it—there are areas that could be improved and other directions that might be explored without threatening the fundamental principle of the NHS. As the Secretary of State said recently, that principle is not and will not be in question. Access to medical care should not be dependent on the ability to pay.
What is certain—the public know this even if the Opposition do not—is that simply to increase the financial input is not the only answer. The Select Committee, of which I am a member, has received a great deal of evidence from experts in every part of the Health Service showing that there is no demonstrable link between levels of spending on health care and a nation's healthiness. That is partly because the Health Service is not the only contributory factor to a nation's health. It has a great deal more to do with the fact that we lack ways of measuring quality and effectiveness in the Health Service.
The amount of money spent by the Americans on health care has been mentioned. It is more or less twice what we spend. Are we to assume that the Americans are twice as healthy or that they have twice as many operations? One needs only one tonsillectomy or appendectomy. Recently I visited Germany to see what could be learned from its system. I did not return with the holy grail but I did learn that there is a great deal about its system that we would be better not to emulate.
The German system is the oldest in Europe and arguably the one on which all others are based. It costs nearly twice what the NHS costs us. It is independent of the state in that more than 1,000 sickness funds, with which the population have to be insured, negotiate terms with local hospitals and practitioners. The service is good for the consumer in that waiting lists are almost unknown. Consumers have a choice. They go straight to the consultant without using the intermediate general practitioner.
However, there is a downside. There are 5,000 surplus doctors looking for jobs and 30,000 surplus beds. There


are complaints from employers about the crippling financial contributions they are expected to make and all the by-products of a producer-led system. The average length of hospital stay is twice that in Britain. Patients are routinely, admitted on a Friday for treatment on a Monday. General practitioners ask their patients quite routinely "How long do you want to be ill for?" Also, equally routinely, patients are given a full body scan when they present with an ingrowing toenail.
The overwhelming problem in Germany is one of escalating costs, from 24 billion deutschmarks in 1970 to 113 billion deutschmarks in 1985. That is inevitable in a system where no one authority has the last word and which is producer-led. The German authorities are, quite rightly, worried about the system. It proved to me that we cannot have a system at which more and more money is thrown and where less and less thought is given to the structures, to choice, to care and to efficiency in the delivery of that care.
We have useful lessons to learn on health care from our neighbours. The French pay at the point of delivery. They pay hotel charges when admitted to hospital. That charge was introduced by a Socialist Government and the French officials we met said that at the time of its introduction it caused a brouhaha. It has at least made the French consumer aware of the costs of the health system.
On the 40th birthday of the NHS I wish it a future that more closely defines what we as a nation expect of it. I believe that the Prime Minister's review will achieve that. It is essential that it is given far better information systems by which to measure its performance. The Griffiths reforms, performance indicators and the Körner systems are all helpful steps in the right direction. We must move from a position where, as Dr. Davies of the British Medical Association said,
all we can really measure is the failure of the system rather than the success of it"—
a point amply illustrated by the contributions from the Opposition today.
The NHS needs to make better use of the skills of its work force as well. I am particularly concerned here with doctors. Doctors' decisions determine policies, not just in spending but also in planning. They will need to accept that their desire, which should be welcomed, to enter the funding and management debate must be balanced by an acceptance on their part that in return the public will want a debate about professional accountability and even about clinical judgment. I want to see a Health Service in which the professional skills of the nursing profession are used to the full and in which we have less arcane rules about the way we use our capital assets and the funds from them.
How shall we achieve this? We shall achieve it by being openminded about the next 40 years for the Health Service; by being prepared to build on what is already happening; to accept, as our neighbours in Europe accept, that the proper blend of private and public sector work, the proper blend of consumerism and professional skill, can bring the same sort of success in the next 40 years as the Health Service has had in the last 40.

Mr. Eric Forth: One of the themes of the debate is the need to recognise that the monolithic National Health Service has given us a

relationship between the producers on the one hand and the consumers and patients on the other that has given rise to a lot of the dissatisfaction that has been expressed today. The clue to the nature of that reversed relationship is perhaps to be found in the paradox that we can spend so much taxpayers' money on a monolithic, centralised Health Service and yet find so much claimed or apparent dissatisfaction. This has given rise to a surprising amount of agreement during the debate about where we should go and where we should seek solutions. The agreement has been mostly on this side of the House, if only because on the Opposition side hardly any hon. Gentlemen have been present. At one stage, indeed, there was only one Back-Bench Opposition Member present, and, with the honourable exception of the hon. Member for Birkenhead (Mr. Field), we have heard no positive or constructive suggestions whatsoever from the Opposition.

Ms. Armstrong: There is a saying that progress is not about being progressive but about moving forward. The Opposition are interested not in the gimmicks but in supporting the Health Service and in ensuring that it can once again have the confidence of the British people. That means working carefully, slowly and openly in a way that the Government are refusing to do.

Mr. Forth: That is a catalogue of shibboleths of the kind that we have come to expect from the Opposition, but we have had absolutely nothing in the way of constructive suggestions. What we have heard outlined today are some key ingredients. [Interruption.] I do not know why Opposition Members who have just come in are getting so excited. If they had been here during the debate they would have heard from Conservative Members a number of suggestions, which I will now summarise for their benefit since they have not done us the courtesy of being here.
The first concerns the availability of information. Free patient choice and choice by general practitioners cannot take place without widespread availability of information about the comparative performance of different aspects of the National Health Service. It is widely agreed now that maximum information about the performance and availability of different types of treatment is necessary so that people can make their own decisions as to whether to wait longer for local treatment or travel further for more immediate treatment. That seems self-evident.
Underpinning that is the concept of what has come to be known as the internal market, or competition between providers. It is essential to the use of the information given to the patient and the doctor that they can then go on to make the freest possible choice among competing providers of health care as to which can provide the best care for the patient at the given moment.
There is widespread agreement among Conservative Members that it would be beneficial for different hospitals and districts to provide in competition with one another the best possible health care to the largest number of patients. Those things go together.
Underlying that concept is an obvious concept that is completely absent from the present Health Service—accountability through the provision of real cost information. I do not know how we can possibly hope to provide effective and efficient health care if there is no concept of the cost of money, the amortisation of equipment and the depreciation of buildings. That alone should provide an obvious answer to those of us who ask


why we are not getting a proper return on our investment. One reason is that what is normal in the business world is totally lacking in the present world of National Health Service care.
I suggest that we should develop the concept of a patients' charter, for want of a better word. We should guarantee to patients of the Health Service that they will be provided with suitable health care within a given period. If the local district cannot provide that, or if they cannot get it from another district in competition with their own, patients should be entitled to go to the private sector for care and send the bill to their local district. If we did that, patients would know what to expect of their Health Service, and we should achieve accountability in the Health Service through the discipline of such a charter.
There has been no lack of suggestions from Conservative Members about how the Health Service can be improved. Ministers will he able to look through the report of the debate and find a catalogue of suggestions on which there is widespread agreement among Conservative Members. Nothing has come from the Opposition. I have the greatest confidence that when the review is completed Ministers will be able to select from a wide variety of options and make positive and effective suggestions for the future of the Health Service.

Ms. Harriet Harman: I welcome the fact that all hon. Members have said that they fully support the National Health Service. However, my right hon. Friend the Member for Blaenau Gwent (Mr. Foot) was right to warn us to fear the outcome of the Prime Minister's review. The Government have been furtive about the review and the Secretary of State has not enlightened us tonight.
It is clear that those at No. 10 Downing street are keen to hear from anyone who has any ideas about how to beef up the private sector and marginalise the National Health Service. Ministers are in a state of panic, and the date of publication of the review keeps slipping back because most of the proposals canvassed so far by the Right—for example, tax relief for private health care and opting out for those who buy private insurance—have bitten the dust as impracticable.
It looks as though only two proposals are still seriously in the running. The first is the abolition of regional health authorities or the reduction of the number of regions by half, which might be a marginal improvement. The second is the introduction of the market into the National Health Service. Many hon. Members have spoken about the internal market. Those who favour the market argue that it would drive down costs if hospitals had to compete for patients. They argue that surplus capacity would be sold at a profit to the health authority and that districts could shop around for best health buys. The first and most fundamental objection to that is that competition drives down the quality of care.
The hon. Member for Lewisham, West (Mr. Maples) talked in glowing terms about competition in the Health Service. The evidence from America, reported in the New England Journal of Medicine—not just about competition between for-profit hospitals but about competition between not-for-profit hospitals—is revealing. The evidence from America is that the fiercer the competition

the higher the mortality rate will be. Put simply, if one is treated in a hospital that has to compete with another hospital for its patients, one is more likely to die.
The reason for the significant correlation between increased mortality rates and competition is that in the competitive environment costs are driven down, corners are cut and the quality of clinical care suffers.
Outcome is the single most important measure of quality in hospital care. The hon. Member for Suffolk, South (Mr. Yeo) was right about that. If one asks people what matters most to them as they enter hospital, they say that they want to get better. They do not want to get worse and they certainly do not want to die. Yet the Government's blanket commitment to markets and their blind belief in competition for everything leads them to ignore that evidence and simply shout no.
The Government have failed to notice the evidence that links competition with mortality rates because they are not interested in the outcome of treatment. They are interested only in the cost of treatment in the Health Service. In health, the Government know the cost of everything and the value of nothing. They talk about the numbers treated but show indifference to whether the result of that treatment is recovery or death.
The Secretary of State has said that performance indicators are a spur to greater efficiency. Only 12 of the 423 performance indicators have anything to do with quality or outcome. All the others measure throughput. The fact that a person is more likely to die in a hospital that is enduring the rigours of the market should, I hope, make most people stop and think—even the right hon. Member for Plymouth, Devonport (Dr. Owen), who is not here at the moment.
Mortality rates are not the only drawback of the internal market. There are other practical problems. My hon. Friend the Member for Kirkcaldy (Dr. Moonie) was right on that point. In theory, a district with spare capacity in one specialty could sell it to a neighbouring authority that has a waiting list and, in turn, that authority could sell its spare capacity in a different specialty. The system could work like that only if neighbouring or nearby authorities had waiting lists or surpluses in different complementary specialties.
If we look at the waiting lists we see that that does not happen. All districts have long waiting lists for general surgery and the only specialty where no district has a waiting list appears to be restorative dentistry. There is no market if all authorities want to buy general surgery and all want to sell restorative dentistry, unless a district sells a specialty in which it already has a waiting list and thereby makes its patients wait even longer. That would happen in practice.
The starting point for the argument in favour of the market is wrong, because it is based on an assumption of spare capacity in the Health Service. My hon. Friend the Member for Normanton (Mr. O'Brien) made it clear that the notion of surplus capacity in the Health Service is laughable. Empty beds, closed wards and unused operating theatres are not symptoms of overcapacity but are caused by underfunding and inadequate nursing policies. It is nonsense to say that there is a surplus when there are people on waiting lists needing services.
Even if there were a scheme for sending patients all over the country, why should they be expected to go? The Government's objective should be to provide services in all districts. We do not want to have a Health Service whereby


if it is piles, one must go to Birmingham; if it is varicose veins, it will be Manchester; and if it is a hernia, Newcastle. Our task is to improve the continuity of care. We need to improve the integration of acute and community services within each district and that task would become impossible with patients shuttling between different districts for routine treatment.
Let us be under no illusion that the market is anything to do with patient's choice. It is nothing of the sort. It reduces patient's choice and the GP's ability to give referral advice. Instead, supremacy is given to the manager's decision about where it is cheapest to treat the patient, not where it is most convenient for the patient or where there is the best chance of success.
The terms in which Ministers and other Conservative Members have talked about health care show that they still resolutely ignore the problems generated by commercialised medicine. When we last debated health care I spoke about the United States and since then have visited the States to see for myself. I was struck particularly by the point that, because health care in America is a business—it is not a health care system; indeed there is no system—with a multiplicity of competing hospitals and doctors, there is no coherent base for planning improvements in care, screening or preventive programmes. It is far too fragmented. Our Health Service provides us with a marvellous base for public health planning, and we fragment that at our peril.
Another sad point that struck me was that patients in America do not trust their doctors in the way that we do. Doctors there have a high status because they are very rich, but the profit motive poisons the doctor-patient relationship.
A doctor in Massachusetts general hospital in Boston told me that many newly qualified doctors come out of medical school owing $50,000 in student loans, so they want to start making money as fast as possible. If a woman over 45 goes into a surgery complaining of abdominal pains she will have a hysterectomy, whether she needs it or not. That is $1,200 in the bank for the doctor straightaway, which is why an American woman is four times more likely than a British woman to have her womb removed. The reason why so many Americans get second medical opinions is not that they are luxuriating enthusiastically in consumer choice: it is because they are terrified of being cut open unnecessarily. Overtreatment caused by the profit motive is an epidemic in the United States, which Congressional committees have had to look into. Not only does it put patients at risk of unnecessary tests and treatment, but it pushes up costs.
People will say that this does not happen here. The reason why overtreatment does not take place on the same scale in the private sector here is that medical culture is set in and dominated by the National Health Service. But let the private sector escape from its marginal position and that would soon change. All hon. Members would have fewer parts than we have now. Like my hon. Friends, I am exasperated by the Government's apparent commitment to the idea that the Health Service should be spending less and that we cannot afford it. One of the problems with the service is that we do not spend enough to make a really first-class service. We could afford to spend far more on it if the Government did not choose instead to squander

public money on tax cuts for the wealthy and on nuclear weapons. The hon. Member for Moray (Mrs. Ewing) was right on that point.
On this, the 40th anniversary of the Health Service, the Government should be making efforts to improve it. First, that means adequate funding. It also means a number of other measures. The Government should be developing better ways to measure the outcome of treatment. They should be setting objectives for improving the outcome of treatment, and implementing ways of monitoring whether those objectives are being met. They should be developing our medical research programme and ensuring that results are acted on in the planning of the health services. They should develop and monitor standards of care and routinely survey patients' views on comfort and care.
We need peer review of doctors by doctors. In addition to medical audit of outcome, peer review would examine whether consultants turned up on time to see patients and whether they cancelled clinics at the last minute. We need to develop peer review of nurses by nurses. The idea of such review is not merely to weed out bad practice and to spot problems, but to enable health care staff to take part in a constant challenging and stimulating debate about how to improve the services that they provide for their patients. That would apply to all care staff, from consultants to hospital porters.
The professional organisations are keen on these ideas. They have been taken up by the British Medical Association and the Royal College of Nursing, and the Health Service unions are also excited by the prospect. Dozens of different quality initiatives are popping up at local level, but the Government are ignoring them because they are terrified of anything that might involve them in more public investment.
Not only hospitals should be involved in the audit. We need to improve the quality of care and services for patients who suffer from long-term or chronic illness, paying more heed to their concerns and examining how we can expand health care services to people in their own homes. I argue that the Government should set up a quality commission for the Health Service. We already have Her Majesty's inspectorates of prisons, of education and of police. But we have no nationwide, overall supervision of standards in the National Health Service, and we need that. Rather than having a large overall flabby body, we should have a small muscular commission that could develop all the initiatives that are taking place at local level. There are such initiatives, and professional inspections are carried out by the royal colleges for training purposes. From time to time, the Government or a regional authority may set up an inquiry into a part of the service or another region. All that, however, is patchy, haphazard and unco-ordinated.
We need to harness the enthusiasm within the Health Service to improve quality, to identify and iron out problems, and to identify and develop good practice. The NHS has served us well for the past 40 years, but under the Conservative Government's spending restrictions much of the energy and enthusiasm among managers, doctors, nurses and other staff has been dissipated and sidetracked in efforts to protect services from the worst of the cuts.
For the future, the service should be properly funded. That is an essential precondition for the years to come. It should also be reorientated away from service-cutting and


penny-pinching. It should be freed from its money worries, and orientated towards pioneering new ways of delivering the highest quality of service to all.

The Minister for Health (Mr. Tony Newton): I rather sense that the hon. Member for Peckham (Ms. Harman) had run out of speech as her Benches have run out of speakers, which has been not the least fascinating of today's developments.
In a debate that has at least produced some important common strands, one that certainly unites the House on this day is a spirit of congratulation towards all who have served in the Health Service during the past 40 years on what they have achieved. I wish to make it clear, because of what is sometimes said on the Opposition Benches, that in my congratulations I include not only doctors and nurses, about whom we are accustomed to talk a great deal, but all who do dedicated work behind the scenes to keep the service running.
Perhaps I might say to the right hon. Member for Blaenau Gwent (Mr. Foot) that, in paying tribute to those who have been involved in the Health Service throughout those years, I have no objection to Nye Bevan and the part that he played. I think that all of us will have listened with considerable respect and interest to the right hon. Gentleman, who is probably the only Member in the House who was present at that time. I must also say gently to him that I might have thought even more highly of his speech had he referred not only to being here at the time of the voting on the National Health Service Act 1946, but to the day barely five years later—23 April 1951, with the Labour Government still in office for another six months—when the then right hon. Member for Ebbw Vale resigned because of what the Labour Government had already proposed to cope with the difficulties in the NHS.
I have looked out the Bevan speech of 23 April 1951, when he resigned over the imposition of charges on spectacles and dentures, and it makes interesting reading. The right hon. Member for Blaenau Gwent made some reference to social security, and I hope that, as he managed to do it, I shall be in order if I follow him. Aneurin Bevan said towards the end of his speech that the then Labour Chancellor said that he was
coming to a complicated and technical matter and that if hon. Members wished to they could go to sleep. They did. Whilst they were sleeping he stole £100 million a year from the National Insurance Fund."—[Official Report, 23 April 1951; Vol. 487, c. 40.]

Mr. Foot: I am sorry that the right hon. Gentleman's report to the House is a little incorrect, but he was not there to hear what happened. Aneurin Bevan was saying that that amount of money had been stolen, and he was reproving Chancellors of the Exchequer who came along and were not sufficiently generous—[HON. MEMBERS: "Labour Chancellors."] Yes, Labour Chancellors. If only the Government would show the devotion to the service that Aneurin Bevan and Hugh Gaitskell showed, we might get on better.

Mr. Newton: My aim was not to pick a quarrel with the right hon. Gentleman but to underline the important recognition that emerged in most of the speeches made on both sides of the House, including the speech made by my hon. Friend the Member for Wycombe (Mr. Whitney), that the problems of funding the Health Service emerged

at an early stage—before the Labour Government had even left office. We must all acknowledge that point in discussing the problems that we face today.

Mrs. Margaret Ewing: How can the right hon. Gentleman reconcile the statement that he is making with the fact that his Department has denied £40 million for social work training to counteract some of the most devastating problems that society faces?

Mr. Newton: Simply because that is incorrect. The Government have increased expenditure on social work training and intend to take further steps to improve social work training. We simply thought that the proposals put forward by the Central Council for Education and Training in Social Work in the document to which the hon. Lady referred were not the best way to make progress in that matter.
Secondly, it is clear that we agree on continuing support for the concept of the Health Service as the foundation of health care, and on the desire to see its capacity to serve our people strengthened still further. Thirdly, and perhaps most remarkably, in view of the spirit in which the debate opened, there has been, apart from speeches from the Opposition Front Bench spokesmen and one or two others, considerable agreement about the need to look at the way in which the service works and to see how we can make it work better. The one distasteful feature of the debate was the attempt by the Opposition, at the outset of the debate, to question that consensus about the basis of the service in the future, and to suggest that, somehow, the NHS is a Labour party preserve.
My right hon. Friend the Secretary of State made nonsense of those claims. I shall repeat only two of the relevant figures. One is that expenditure in real terms has risen by well over one third under this Government, and the second is that the percentage share that the NHS takes of Britain's gross domestic product, which fell slightly under the previous Administration, has risen substantially under this. What is just as important as the fact that we have been putting more resources in is that we have been making better use of those resources. What are known, in admittedly not very pleasing jargon, as the cost improvement programmes have the practical meaning that another £600 million has been released for caring for patients. The result is those huge increases in the number of patients treated, and in the proportion of each——

Ms. Armstrong: No.

Mr. Newton: If the hon. Lady is suggesting that there has not been an increase, let me give her the figures.

Ms. Armstrong: I was trying to make the point that there are more people ill now, and more people need medical care because of the change in demography and the rise in unemployment.

Mr. Newton: With the greatest possible respect, which is not a great deal in view of what the hon. Lady has just said, I shall just give her the index of the treatment rates per 10,000 population for the over-75s. On an index of treatment rates per 10,000 population, between 1974 and 1979 the figure rose from 100 to 109, and between 1979 and 1985 it rose from 109 to 137. That is a dramatic increase. Those figures have been given to the Select Committee, so the hon. Lady can read them. They can be repeated for almost every part of the population.

Mr. Robin Corbett: Does the right hon. Gentleman know that in Sutton Coldfield, the constituency of the former Secretary of State for Social Services, there are 112 beds for which the regional health authority cannot find funding, and that the opening of a £2 million treatment centre, including a hydrotherapy treatment pool, cannot be opened because the regional health authority says that there is not the money to put the staff—[HON. MEMBERS: "Rubbish."] It is not rubbish; it is true. The regional health authority says that it has not the money to engage staff to treat children and others with rheumatoid arthritis. If everything is so good, why are things so bad in the hospitals serving my constituency?

Mr. Newton: I hope that the hon. Gentleman will acknowledge that any problems in the Health Service—no one is suggesting that there are none—are very much the problems of a service that is expanding and investing in new equipment and treating more people than ever before. Indeed, the hon. Gentleman's question indicates that self-same point.
It has become a cliché to say that the Health Service is in some sense the victim of its own success. It is true that many of the problems and pressures, which unquestionably are faced, despite the largest capital building programme, for example, in the history of the west midlands region, are caused by continually rising demand. The very fact that we have been so much more successful in keeping alive babies who would have died not so many years ago means that young children need more care than would otherwise have been required. The very fact that life expectancy continues to rise because of the success of the service generates the demands that lead to the increases in treatment rates to which I referred.
Of course, the combination of those demographic trends and our capacity to provide more treatment is reflected in how we have tried to develop the service. We have more than kept pace with the demands, as the treatment rates that I quoted show.

Mr. Burt: While my right hon. Friend is in this area, will he note that today, in the model health authority of Bury—where there has been a 40 per cent. increase in consultants during the past seven years, and where the number of in-patients treated has risen by 20 per cent. per year since 1978—the keys were handed over on completion of phase 1 of the new £30 million Fairfield general hospital? Is not that another example of our care for the NHS?

Mr. Newton: I am obviously delighted to know that the 40th anniversary of the NHS has been celebrated in such an appropriate way in my hon. Friend's constituency.
As I was saying, the figures that I gave to the hon. Member for Durham, North-West (Ms. Armstrong) a few moments ago show clearly that we have not merely been keeping pace with, but moving ahead of, rising demands, generated by demography and our capacity to provide more treatment to more people. We also know that however successful we have been in the past——

Mr. Kevin Barron: rose——

Mr. Brian Willson: rose——

Mrs. Margaret Ewing: rose——

Mr. Newton: I shall not give way at the moment.
Nobody can deny the success, bearing in mind the number of patients treated, the number of new treatments introduced and other conceivable measures. However successful we have been in the past 40 years or in the past 10 years though, demand and the desire for new treatments will continue to increase. It is to see how that demand can best be met that we have set in hand the review which has been the focus of much of the debate.
The hon. Member for Kirkcaldy (Dr. Moonie), no doubt anticipating some of the sedentary demands being made by Opposition Members, wanted to hear the conclusions of the review. I am unable to help him tonight, but whatever conclusions the review reaches, it is clear that it will build on a great deal that has already been achived or has been set in hand by the Government during the past eight or nine years.

Mr. Robin Cook: As the Minister has at last got to the review, may I put to him the question which has lain unanswered throughout the debate and which I posed at the beginning of the day? Will he give the House an assurance that, when the review is completed, the House will receive the courtesy of hearing the results—or is the announcement to be reserved for the Conservative party conference, thus showing the party political nature of the review right from the start?

Mr. Newton: When we have completed the review, we will decide on the appropriate way in which to make our conclusions known. It is clear that the review's conclusions will make use of a great deal of work that has been set in hand, and which has been announced and is clear to the House.
The first element will be improvement in management in the service, set in train after the first Griffiths report, the beneficial results of which have been mentioned by many of my hon. Friends, and can be seen in health authorities throughout the country. The hon. Member for Birkenhead (Mr. Field), the Chairman of the Social Services Select Committee, made a thoughtful speech. One of the things that we want to do to strengthen the management process—which has been called for by several of my hon. Friends—is to make more targeted use of funds we make available to support good management. The waiting list initiative is a prime example of what can be, and is being, achieved by those means.
There has been unanimity about the need to improve the flow of information to managers, patients, others throughout the service and, indeed, Members of Parliament about how health authorities operate. That information may still not be as good as we would like or as we want to make it, but it is already a great deal better than it was when the Government came to office. It is already being used by health authorities to improve services.

Mr. Wilson: Will the right hon. Gentleman give way?

Mr. Newton: No.
Contrary to what the hon. Member for Peckham said, we want to put more emphasis—as we have already done—on the range of choice available to people and the quality of service they receive. For once, I find myself agreeing with the right hon. Member for Birmingham, Sparkbrook (Mr. Hattersley), who I understand made a speech in Scotland today. I am not sure how what he said fits with what the hon. Lady said in the latter part of her


speech, when she seemed to be flatly opposed to what the right hon. Gentleman said. He said that patients should choose their consultants, the day and time of their hospital appointments and have a greater opportunity to change GPs.

Mr. Corbett: Everybody wants that.

Mr. Newton: For once, the right hon. Member for Sparkbrook is pushing at an open door. It is this Government who have set in hand——

Mrs. Margaret Ewing: rose——

Mr. Barron: rose——

Mr. Newton: It is time that Opposition Members listened a hit.
It is this Government who have set in hand the spreading of better information about where the waiting lists are and what the referral patterns are. It is this Government who have set in hand the improvement of complaints procedures and the possibilities of choice of GPs. It is this Government's policy that patients should be given more information about the general practices and other health facilities in their constituencies, and it is this Government who have launched a quality of service initiative throughout the health authority world.

Mr. Barron: On the question of patient choice, perhaps the Minister can square his comments with what happened to one of my constituents, Mr. Tom Rossington, who is 93 years old and who, in the autumn of last year, went to his GP and was told that he would have to wait until July of this year to have an examination for his eye cataracts. He ended up seeing the same surgeon in Parkfield hospital in Rotherham a fortnight later for the sum of £70. Is that the choice for 93-year-old people in Britain today?

Mr. Newton: Our aim and achievement has been dramatically to increase the number of cataract operations that take place in this country.
Finally, we shall seek to build further on what we have done to improve health promotion and the prevention of ill health in this country, for example, by the development of cervical cancer screening and, for the first time in this country, by a full-scale breast cancer screening programme.

Mr. Neil Kinnock: The whole House is listening with interest to the way in which the right hon. Gentleman is describing the projections and hopes for the future. Will he tell us whether he accepts the view of the British Medical Association that the NHS still faces a major crisis? What is his view of the need expressed by the BMA and the Select Committee that, this year, it is necessary to have an additional £1 billion to £1·5 billion of expenditure to ensure that there will not be a repetition of this year's crisis?

Mr. Newton: The right hon. Gentleman has simply confirmed his reputation for being a man who, whenever he is offered a choice of weapons, chooses a boomerang.

Mr. Kinnock: Answer the question.

Mr. Newton: I shall answer the right hon. Gentleman by going back to the 30th anniversary of the Health Service. On 5 July 1978, when the then Labour

Government were trying to get the BMA to sign a declaration about how marvellous everything was, The Times reported:
In its statement the BMA said that the health service was failing to provide the service that patients had been led to expect and doctors were no longer willing to cover up its deficiencies. The anniversary"—
the Labour party's anniversary—
could not be an occasion for rejoicing, but must be a time far serious appraisal of how to find more resources and boost the morale in all health service workers.
As I said, the Leader of the Opposition always chooses a boomerang and he has chosen an even better one than usual.
Opposition Members will have been expecting me to say something about the winter of discontent, but I am not going to say anything about that. I am going to say something about the summer of discontent that preceded it. I shall refer to one more headline that appeared on 6 June 1978, a month before the 30th anniversary. It reads:
Nurses heckle Mr. Ennals over NHS 'complacency"'.
The nurses jeered him. A month ago the nurses gave my right hon. Friend the Secretary of State a standing ovation.

Question put, That the original words stand part of the Question:—

The House divided; Ayes 217, Noes 287.

Division No. 396]
[10 pm


AYES


Abbott, Ms Diane
Cox, Tom


Adams, Allen (Paisley N)
Crowther, Stan


Allen, Graham
Cryer, Bob


Alton, David
Cummings, John


Anderson, Donald
Cunliffe, Lawrence


Archer, Rt Hon Peter
Cunningham, Dr John


Armstrong, Hilary
Dalyell, Tarn


Ashley, Rt Hon Jack
Davies, Rt Hon Denzil (Llanelli)


Ashton, Joe
Davies, Ron (Caerphilly)


Banks, Tony (Newham NW)
Davis, Terry (B'ham Hodge H'l)


Barnes, Harry (Derbyshire NE)
Dewar, Donald


Barnes, Mrs Rosie (Greenwich)
Dixon, Don


Barron, Kevin
Dobson, Frank


Battle, John
Doran, Frank


Beckett, Margaret
Duffy, A. E. P.


Beith, A. J.
Dunnachie, Jimmy


Bell, Stuart
Dunwoody, Hon Mrs Gwyneth


Benn, Rt Hon Tony
Eadie, Alexander


Bennett, A. F. (D'nt'n &amp; R'dish)
Evans, John (St Helens N)


Bermingham, Gerald
Ewing, Mrs Margaret (Moray)


Bidwell, Sydney
Fatchett, Derek


Boateng, Paul
Fearn, Ronald


Boyes, Roland
Field, Frank (Birkenhead)


Bradley, Keith
Fields, Terry (L'pool B G'n)


Brown, Gordon (D'mline E)
Flannery, Martin


Brown, Nicholas (Newcastle E)
Flynn, Paul


Brown, Ron (Edinburgh Leith)
Foot, Rt Hon Michael


Buchan, Norman
Foster, Derek


Buckley, George J.
Fraser, John


Caborn, Richard
Fyfe, Maria


Callaghan, Jim
Galbraith, Sam


Campbell, Menzies (Fife NE)
Galloway, George


Campbell, Ron (Blyth Valley)
Garrett, John (Norwich South)


Campbell-Savours, D. N.
Garrett, Ted (Wallsend)


Canavan, Dennis
George, Bruce


Cartwright, John
Godman, Dr Norman A.


Clark, Dr David (S Shields)
Golding, Mrs Llin


Clarke, Tom (Monklands W)
Gordon, Mildred


Clay, Bob
Graham, Thomas


Clelland, David
Grant, Bernie (Tottenham)


Clwyd, Mrs Ann
Griffiths, Nigel (Edinburgh S)


Cohen, Harry
Grocott, Bruce


Coleman, Donald
Hardy, Peter


Cook, Robin (Livingston)
Harman, Ms Harriet


Corbett, Robin
Haynes, Frank


Corbyn, Jeremy
Healey, Rt Hon Denis


Cousins, Jim
Heffer, Eric S.






Henderson, Doug
Nellist, Dave


Hinchliffe, David
Oakes, Rt Hon Gordon


Hogg, N. (C'nauld &amp; Kilsyth)
O'Brien, William


Holland, Stuart
O'Neill, Martin


Home Robertson, John
Orme, Rt Hon Stanley


Hood, Jimmy
Owen, Rt Hon Dr David


Howarth, George (Knowsley N)
Paisley, Rev Ian


Howell, Rt Hon D. (S'heath)
Patchett, Terry


Howells, Geraint
Pendry, Tom


Hoyle, Doug
Prescott, John


Hughes, John (Coventry NE)
Radice, Giles


Hughes, Robert (Aberdeen N)
Randall, Stuart


Hughes, Roy (Newport E)
Redmond, Martin


Hughes, Sean (Knowsley S)
Rees, Rt Hon Merlyn


Hughes, Simon (Southwark)
Reid, Dr John


Illsley, Eric
Richardson, Jo


Ingram, Adam
Roberts, Allan (Bootle)


Janner, Greville
Robertson, George


John, Brynmor
Robinson, Geoffrey


Jones, leuan (Ynys Môn)
Rooker, Jeff


Jones, Martyn (Clwyd S W)
Rowlands, Ted


Kennedy, Charles
Ruddock, Joan


Kinnock, Rt Hon Neil
Salmond, Alex


Leadbitter, Ted
Sedgemore, Brian


Lestor, Joan (Eccles)
Sheerman, Barry


Lewis, Terry
Sheldon, Rt Hon Robert


Litherland, Robert
Shore, Rt Hon Peter


Livingstone, Ken
Short, Clare


Livsey, Richard
Skinner, Dennis


Lloyd, Tony (Stretford)
Smith, Andrew (Oxford E)


Lofthouse, Geoffrey
Smith, C. (Isl'ton &amp; F'bury)


Loyden, Eddie
Smyth, Rev Martin (Belfast S)


McAllion, John
Snape, Peter


McAvoy, Thomas
Soley, Clive


Macdonald, Calum A.
Spearing, Nigel


McFall, John
Steinberg, Gerry


McGrady, Eddie
Stott, Roger


McKay, Allen (Barnsley West)
Strang, Gavin


McKelvey, William
Straw, Jack


McLeish, Henry
Taylor, Mrs Ann (Dewsbury)


Maclennan, Robert
Taylor, Matthew (Truro)


McTaggart, Bob
Thomas, Dr Dafydd Elis


McWilliam, John
Turner, Dennis


Madden, Max
Vaz, Keith


Mahon, Mrs Alice
Wall, Pat


Marek, Dr John
Wallace, James


Marshall, David (Shettleston)
Walley, Joan


Marshall, Jim (Leicester S)
Warden, Gareth (Gower)


Martin, Michael J. (Springburn)
Wareing, Robert N.


Martlew, Eric
Welsh, Andrew (Angus E)


Maxton, John
Welsh, Michael (Doncaster N)


Meacher, Michael
Wigley, Dafydd


Meale, Alan
Williams, Rt Hon Alan


Michie, Bill (Sheffield Heeley)
Williams, Alan W. (Carm'then)


Millan, Rt Hon Bruce
Wilson, Brian


Mitchell, Austin (G'f Grimsby)
Winnick, David


Moonie, Dr Lewis
Wise, Mrs Audrey


Morgan, Rhodri
Worthington, Tony


Morley, Elliott
Wray, Jimmy


Morris, Rt Hon A. (W'shawe)



Morris, Rt Hon J. (Aberavon)
Tellers for the Ayes:


Mowlam, Marjorie
Mr. Alun Micheal and


Mullin, Chris
Mr. Ray Powell


Murphy, Paul





NOES


Adley, Robert
Beaumont-Dark, Anthony


Aitken, Jonathan
Bellingham, Henry


Alexander, Richard
Bendall, Vivian


Allason, Rupert
Bennett, Nicholas (Pembroke)


Amess, David
Benyon, W.


Amos, Alan
Bevan, David Gilroy


Arbuthnot, James
Biffen, Rt Hon John


Arnold, Jacques (Gravesham)
Biggs-Davison, Sir John


Ashby, David
Blackburn, Dr John G.


Atkinson, David
Blaker, Rt Hon Sir Peter


Baker, Nicholas (Dorset N)
Body, Sir Richard


Baldry, Tony
Bonsor, Sir Nicholas


Banks, Robert (Harrogate)
Boscawen, Hon Robert


Batiste. Spencer
Boswell, Tim





Bottomley, Peter
Greenway, Harry (Ealing N)


Bottomley, Mrs Virginia
Greenway, John (Ryedale)


Bowden, A (Brighton K'pto'n)
Griffiths, Sir Eldon (Bury St E')


Bowden, Gerald (Dulwich)
Griffiths, Peter (Portsmouth N)


Bowis, John
Ground, Patrick


Boyson, Rt Hon Dr Sir Rhodes
Grylls, Michael


Braine, Rt Hon Sir Bernard
Gummer, Rt Hon John Selwyn


Brandon-Bravo, Martin
Hamilton, Hon Archie (Epsom)


Brazier, Julian
Hamilton, Neil (Tatton)


Bright, Graham
Hanley, Jeremy


Brooke, Rt Hon Peter
Hannam, John


Brown, Michael (Brigg &amp; Cl't's)
Hargreaves, A. (B'ham H'll Gr')


Browne, John (Winchester)
Hargreaves, Ken (Hyndburn)


Bruce, Ian (Dorset South)
Harris, David


Buchanan-Smith, Rt Hon Alick
Haselhurst, Alan


Buck, Sir Antony
Hawkins, Christopher


Burns, Simon
Hayhoe, Rt Hon Sir Barney


Burt, Alistair
Hayward, Robert


Butcher, John
Heathcoat-Amory, David


Butler, Chris
Heddle, John


Butterfill, John
Heseltine, Rt Hon Michael


Carlisle, John, (Luton N)
Higgins, Rt Hon Terence L.


Carrington, Matthew
Hill, James


Carttiss, Michael
Hind, Kenneth


Cash, William
Hogg, Hon Douglas (Gr'th'm)


Chalker, Rt Hon Mrs Lynda
Holt, Richard


Chapman, Sydney
Hordern, Sir Peter


Chope, Christopher
Howard, Michael


Churchill, Mr
Howarth, Alan (Strat'd-on-A)


Clark, Hon Alan (Plym'th S'n)
Howarth, G. (Cannock &amp; B'wd)


Clark, Dr Michael (Rochford)
Howe, Rt Hon Sir Geoffrey


Clark, Sir W. (Croydon S)
Howell, Rt Hon David (G'dford)


Clarke, Rt Hon K. (Rushcliffe)
Howell, Ralph (North Norfolk)


Colvin, Michael
Hughes, Robert G. (Harrow W)


Conway, Derek
Hunt, David (Wirral W)


Coombs, Anthony (Wyre F'rest)
Hunt, John (Ravensbourne)


Cope, Rt Hon John
Hunter, Andrew


Cormack, Patrick
Hurd, Rt Hon Douglas


Couchman, James
Irvine, Michael


Cran, James
Irving, Charles


Critchley, Julian
Jack, Michael


Currie, Mrs Edwina
Janman, Tim


Davies, Q. (Stamf'd &amp; Spald'g)
Jessel, Toby


Davis, David (Boothferry)
Johnson Smith, Sir Geoffrey


Day, Stephen
Jones, Gwilym (Cardiff N)


Devlin, Tim
Jones, Robert B (Herts W)


Dickens, Geoffrey
Jopling, Rt Hon Michael


Dicks, Terry
Kellett-Bowman, Dame Elaine


Douglas-Hamilton, Lord James
Key, Robert


Dunn, Bob
Kilfedder, James


Durant, Tony
Knapman, Roger


Dykes, Hugh
Knight, Dame Jill (Edgbaston)


Emery, Sir Peter
Lawson, Rt Hon Nigel


Evans, David (Welwyn Hatf'd)
Leigh, Edward (Gainsbor'gh)


Evennett, David
Lennox-Boyd, Hon Mark


Fallon, Michael
Lightbown, David


Farr, Sir John
Lloyd, Peter (Fareham)


Favell, Tony
Lord, Michael


Field, Barry (Isle of Wight)
Macfarlane, Sir Neil


Fookes, Miss Janet
Maclean, David


Forman, Nigel
Major, Rt Hon John


Forsyth, Michael (Stirling)
Malins, Humfrey


Forth, Eric
Maples, John


Fowler, Rt Hon Norman
Marland, Paul


Fox, Sir Marcus
Martin, David (Portsmouth S)


Franks, Cecil
Mates, Michael


Freeman, Roger
Maude, Hon Francis


French, Douglas
Miscampbell, Norman


Fry, Peter
Mitchell, Andrew (Gedling)


Gale, Roger
Moate, Roger


Gardiner, George
Monro, Sir Hector


Garel-Jones, Tristan
Moore, Rt Hon John


Gill, Christopher
Neale, Gerrard


Gilmour, Rt Hon Sir Ian
Needham, Richard


Glyn, Dr Alan
Nelson, Anthony


Goodson-Wickes, Dr Charles
Neubert, Michael


Gorman, Mrs Teresa
Newton, Rt Hon Tony


Gorst, John
Nicholls, Patrick


Gow, Ian
Nicholson, David (Taunton)


Grant, Sir Anthony (CambsSW)
Onslow, Rt Hon Cranley






Oppenheim, Phillip
Shepherd, Colin (Hereford)


Page, Richard
Shepherd, Richard (Aldridge)


Parkinson, Rt Hon Cecil
Shersby, Michael


Patnick, Irvine
Sims, Roger


Patten, John (Oxford W)
Skeet, Sir Trevor


Pattie, Rt Hon Sir Geoffrey
Smith, Sir Dudley (Warwick)


Pawsey, James
Smith, Tim (Beaconsfield)


Peacock, Mrs Elizabeth
Soames, Hon Nicholas


Porter, Barry (Wirral S)
Speller, Tony


Porter, David (Waveney)
Spicer, Sir Jim (Dorset W)


Portillo, Michael
Spicer, Michael (S Worcs)


Powell, William (Corby)
Squire, Robin


Price, Sir David
Stanbrook, Ivor


Raffan, Keith
Steen, Anthony


Raison, Rt Hon Timothy
Stern, Michael


Rathbone, Tim
Stewart, Allan (Eastwood)


Redwood, John
Stewart, Andy (Sherwood)


Renton, Tim
Stewart, Ian (Hertfordshire N)


Rhodes James, Robert
Stokes, Sir John


Riddick, Graham
Stradling Thomas, Sir John


Ridley, Rt Hon Nicholas
Sumberg, David


Ridsdale, Sir Julian
Summerson, Hugo


Roberts, Wyn (Conwy)
Tapsell, Sir Peter


Roe, Mrs Marion
Taylor, Ian (Esher)


Rost, Peter
Taylor, John M (Solihull)


Rumbold, Mrs Angela
Taylor, Teddy (S'end E)


Ryder, Richard
Tebbit, Rt Hon Norman


Sackville, Hon Tom
Temple-Morris, Peter


Sainsbury, Hon Tim
Thatcher, Rt Hon Margaret


Sayeed, Jonathan
Thompson, D. (Calder Valley)


Shaw, David (Dover)
Thompson, Patrick (Norwich N)


Shaw, Sir Giles (Pudsey)
Thorne, Neil


Shaw, Sir Michael (Scarb')
Thornton, Malcolm


Shelton, William (Streatham)
Thurnham, Peter


Shephard, Mrs G. (Norfolk SW)
Townend, John (Bridlington)





Tracey, Richard
Whitney, Ray


Tredinnick, David
Widdecombe, Ann


Trippier, David
Wiggin, Jerry


Trotter, Neville
Wilkinson, John


Twinn, Dr Ian
Wilshire, David


Viggers, Peter
Winterton, Mrs Ann


Waddington, Rt Hon David
Winterton, Nicholas


Waldegrave, Hon William
Wood, Timothy


Walden, George
Woodcock, Mike


Walker, Bill (T'side North)
Yeo, Tim


Waller, Gary
Young, Sir George (Acton)


Walters, Sir Dennis
Younger, Rt Hon George


Ward, John



Wardle, Charles (Bexhill)
Tellers for the Noes:


Watts, John
Mr. Kenneth Carlisle and


Wells, Bowen
Mr. Stephen Dorrell.


Wheeler, John

Question accordingly negatived.

Question, That the proposed words be there added, put fOrthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

MR. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved,
That this House warmly congratulates present and past staff of the National Health Service on forty years service to the public; recognises the achievements of Her Majesty's Government, firmly based on a strong economy, in devoting resources to the Service to enable both hospitals and community services to provide more care than ever before; and welcomes the current review to ensure that the Health Service is even better in the years ahead.

Education (Assisted Places)

The Parliamentary Under-Secretary of State for Education and Science (Mr. Bob Dunn): I beg to move,
That the draft Education (Assisted Places) (Amendment) Regulations 1988, which were laid before this House on 13th June, be approved.
I begin this short debate on these important regulations by saying how much I welcome the tone of earlier debates. The hon. Member for Blackburn (Mr. Straw), in an article in The Guardian on 23 March, said:
First, we must recognise that a nation of consumers enjoying relatively high living standards becomes literally much more choosy, much more interested in choice and variety.
That is exactly so.
Before I begin the main text of my speech, I should be interested to know whether the Opposition will reveal that the think tank set up and run by Lady Antonia Fraser will be important and instrumental in the decision making leading to educational philosophy in the Labour party for the years ahead. We need to know whether the new think tank will be advising the Opposition.[Interruption.]

Mr. Dennis Skinner: Tell them to go back to the boozer.

Mr. Speaker: Perhaps the hon. Member for Bolsover (Mr. Skinner) will join them.

Mr. Skinner: On a point of order, Mr. Speaker. I was a miner for 21 years and was not allowed to go down the pit shaft, along with other miners, reeking of ale. When I first came here I decided that in no circumstances would I come to the Chamber and legislate for the country reeking of ale. I have never been in any of those places, and you know that, Mr. Speaker.

Mr. Speaker: Order. Let us get on with the debate.

Mr. Dunn: By tradition, our debates are always conducted with great calmness.
Before I was interrupted by the hon. Member for Bolsover (Mr.Skinner), I was saying that I was anxious to establish the precise role of the think tank in the development of the Labour party's education policy. When Lady Antonia Fraser refers to the development of education philosophy, I dare say that her knowledge of the state system of education will be drawn from many years' experience of handing out bounty in Belgravia. I always thought that Lady Antonia Fraser was a Conservative. I understand that she is now a member of the Labour party—without even having to rearrange her jewellery.
For the benefit of Opposition Members, perhaps it would be helpful to explain that the principal regulations governing the administration of the assisted places scheme require annual amendment to take account of the necessary revaluation of parental income scales and changes introduced in the Finance Act 1987. In the past we have also taken this opportunity to make various small amendments for which experience of the scheme has suggested a need. This year such an amendment takes account of cases where court orders for payment of school fees are in force. I venture to suggest that all the amendments—which I shall describe in a moment—are relatively straightforward.
Briefly, perhaps I might set the regulations in context. There are currently more than 27,000 pupils holding assisted places at 234 of the best independent schools in England and Wales. High academic standards are a prerequisite of a school's participation in the scheme.
As the House will recognise, the scheme continues to be both popular and successful. While the scale governing the level of fee remission is intentionally a tough one, 37 per cent. of assisted pupils qualify for full fee remission. In the current academic year these are pupils from families where the joint income was at or below £6,972 a year. Therefore, the assisted places scheme is clearly benefiting families who would otherwise be unable to send their children to these excellent schools.
I can tell the House with pride, as I do on these annual occasions, that the scheme has gone from strength to strength since its inception in 1981, and we intend to build on that success by expanding the number of available places in England and Wales to an eventual total of 35,000.

Ms. Hilary Armstrong: I am interested in what the Minister has to say. Is he able to reassure us that the children who, in his words, will benefit from the expenditure of that public money will be subject to the national curriculum?

Mr. Dunn: The hon. Member for Durham, North-West (Ms. Armstrong) is now becoming an experienced hand at the sort of dodgem techniques that we have come to expect in the House from the Opposition. Because they have nothing to offer in the way of philosophy, they carp and whinge, no matter how eloquently that carping and whingeing may be done, although the hon. Lady does it better than most.
Regulation 1(1) is concerned with title and timing. Hon. Members will not, I judge, require any detailed comment on it from me.
Regulation 1(2) allows bursars to use the new parental income scales ahead of the start of term for determining a child's eligibility and assessing fee remission questions for existing assisted pupils.
Regulation 2 introduces a new condition of eligibility. This is that a child all of whose fees are required to be paid under a court order may not be selected for an assisted place. It also removes entitlement to remission of any part of school fees required to be paid under a court order. This latter provision will apply in the case of a child who is about to join the APS or is already the holder of an assisted place. Any portion of fees which is required to be paid under a court order will no longer attract fee remission.
Regulation 3 arises from the Finance Act 1987 and the Finance (No. 2) Act 1987 and brings up to date the references to the relevant income tax legislation in schedule 1 to the principal Education (Assisted Places) Regulations 1985. Deductions from total income in respect of increased personal reliefs for those aged 80 or over and contributions to personal pension schemes are not to be made in calculating relevant income for the purposes of assessing fee remission.
Draft regulation 4 provides for the updating of the income scale used for assessing the amount of parents' contributions towards the fees. The threshold at or below which parents pay nothing towards fees is raised from £6,972 to £7,258.
The amendments I have just described are essentially good housekeeping and I know that they will find favour with the House.

Mr. Derek Fatchett: The Under-Secretary, in his usual way, made a wide-ranging speech. We are grateful to him for his detailed introduction of the regulations and we all welcomed his opening remarks. Some scurrilous newspapers suggest that this may be the hon. Gentleman's valedictory speech from the Dispatch Box. If he wants anybody to put in a word on his behalf with the Prime Minister, I am sure that some of my hon. Friends will be happy to do so.
This is a debate tinged with a certain disappointment. We have lost the pleasure of the company of the Minister of State, the hon. Member for Mitcham and Morden (Mrs. Rumbold). When I first heard that the hon. Member for Dartford (Mr. Dunn) would be dealing with the regulations, I realised that it might be because the hon. Lady is now taking a much keener interest in planning matters and looking after the interests of the Secretary of State for the Environment rather than bothering herself too much with educational matters. It is noticeable how in that capacity the hon. Lady has developed a fairly wide brief, a much larger constituency, and that the interest in Morden extends to some very strange parts of London.

Dame Elaine Kellett-Bowman: Will the hon. Gentleman get to the regulations?

Mr. Fatchett: I will indeed. The comments of the hon. Lady are always very welcome and I will certainly concentrate on the regulations. I listen always to the hon. Lady's comments because I am sure that they should be heeded.
The other element of disappointment, if I can just comment on this, Mr. Deputy Speaker, without being chastised by you or others, is that we are not blessed with the presence of the spokesperson of the alliance party—[HON. MEMBERS: "Which one?"] Whatever they now call themselves. Hon. Members may well understand my difficulties in that respect. If we have heard the valedictory speech of the Under-Secretary of State for Education and Science—which I am sure we have not—I am not quite sure what we can expect from the hon. Member for Brecon and Radnor (Mr. Livsey); perhaps he is just keeping the seat warm for the hon. Member for Yeovil (Mr. Ashdown) who is out campaigning to get himself an assisted place as leader of the SLD.
The Minister said that the scheme was a major success. That hardly corresponds to the facts. In 1986 the number of youngsters entering the assisted places scheme fell from 5,146 to 4,905. There has in fact been a reversal in the number of youngsters going into the scheme, despite the Minister's heady rhetoric to the effect that the objective was to gain 35,000 assisted places.
The regulations and the principle of the assisted places scheme tell us a good deal about the Government's attitude to education and the state sector. They tell us much about the notion that we have independent schools. The very nature of the assisted places scheme is state intervention and public money keeping private schools in operation.
When we debated the national curriculum we were told by Conservative Members that the national curriculum

should not apply to private schools because they were thoroughly independent. The workings of the assisted places scheme tell us that the private schools are in no sense independent. In many cases, they rely on the state for money.
Let us consider just a few of the schools that are part of the assisted places scheme and rely heavily on that scheme for their students. At Batley grammar school, 37 per cent. of the pupils come through the assisted places scheme. At Belvedere school, it is 27 per cent. [HON. MEMBERS: "Excellent."] At both Birkenhead high school and Birkenhead school the figure is 24 per cent. At Bristol Cathedral school it is 28 per cent.; at Dame Allan's boys school it is 30 per cent. [HoN. MEMBERS: "Better still."] At Farnborough hill school, it is 34 per cent. At King Edward's school Birmingham, it is 37 per cent. At St. Edwards college it is 39 per cent.

Mr. Robert Key: Will the hon. Gentleman give way?

Mr. Fatchett: I shall give way to the hon. Gentleman in a moment. The hon. Gentleman and his hon. Friends said "Better and better" to each increased percentage that I cited. Where is the argument about independence? The schools are not independent, they are maintained by the Exchequer and the taxpayer. That is why we have always argued that they should be included in the provisions for the national curriculum.

Mr. Key: The taxpayer argument is a non-starter because those who choose independent education pay twice anyway. It was with great relief that the independent sector heard the hon. Member for Durham, North-West (Ms. Armstrong)—it was widely reported in the national newspaper of the Independent Schools Information Service—say that it was now Labour party policy that the independent schools would not be abolished.

Mr. Deputy Speaker (Mr. Harold Walker): Order. Interesting as all this may be, it has very little to do with the regulations before the House. I hope that hon. Members will stick to the regulations.

Mr. Fatchett: I am grateful to you, Mr.Deputy Speaker. You are always willing to teach Conservative Members about the necessary procedures of debate—

Mr. Deputy Speaker: Order. Hon. Members on both sides of the House must stick to the regulations.

Mr. Fatchett: I shall certainly not be tempted any further into debates about the independent schools—[Interruption.] Mr. Deputy Speaker has said that I must not be tempted further. Otherwise, I should love to continue.
The scheme is much like the city technology colleges: it tells us a lot about the Government's values and priorities. They are prepared to spend more on a relatively small number of youngsters than on all our children in terms of the development of the national curriculum.
Some of the places covered by the regulations cost more than £5,000 per year per child, yet when a local education authority spends half that on each child—as did, for example, the Inner London education authority—it is rate-capped and subject to abolition. According to the Government, it is right to invest more than £5,000 a year in a small number of children, yet it is wrong to spend only half that sum on each of the 250,000 children of inner


London. The Inner London education authority is told by the Government that that expenditure is profligate and wasteful.

The Minister of State, Department of Education and Science (Mrs. Angela Rumbold): It is wasteful.

Mr. Fatchett: The Minister of State says that that expenditure is wasteful. How does she justify much higher expenditure on the assisted places scheme? The justification is that the Government believe in paying for an elite few. We believe in investing in and looking after all our children. I am willing to give way to the Minister on that point.

Mr. Deputy Speaker: Order. I remind the House that the merits or otherwise of the scheme have been decided by the House. We are discussing the narrow issues raised by the regulations, not the merits of the assisted places scheme.

Mr. Bob Cryer: On a point of order, Mr. Deputy Speaker. It has never been the custom of the House in debating statutory instruments by affirmative resolution to exclude the merits of those instruments. There is what is known as a merits committee. When a Joint Committee or Select Committee deals with instruments and makes recommendations to the House, it is not allowed, according to its terms of reference, to discuss the merits. That is because the full House or a Statutory Instruments Committee can discuss them.

Mr. Deputy Speaker: The merits of the assisted places scheme have been determined by the House in primary legislation. We are now discussing a statutory instrument which deals with a detail of that scheme, and hon. Members must confine their remarks to that.

Mr. Jack Straw: Further to the point of order, Mr. Deputy Speaker. My hon. Friend the Member for Bradford, South (Mr. Cryer) has raised a serious point. With respect, "Erskine May" does not say that the debate must be confined to the detail of the regulations. It says:
Debate…is confined to the contents of the instrument".
My hon. Friend the Member for Leeds, Central (Mr. Fatchett) is arguing why, on the contents of the regulations, the House should vote against them.

Mr. Skinner: Further to the point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker: Order. One point of order at a time.
The hon. Member for Blackburn (Mr. Straw) has confirmed what I said to the House—the debate must be confined to the contents of the regulations before the House. I am asking the House to recognise that fact.

Mr. Skinner: Further to the point of order, Mr. Deputy Speaker. I was present at the beginning of the debate when the Under-Secretary of State for Education and Science—the hon. Member for Dartford (Mr. Dunn)—got to his feet. Mr. Speaker was in the Chair, rather than you, Sir, and perhaps you did not hear everything. The Minister spoke about the merits of the matter. If you had been in the Chair, you probably would have pulled him up on the same basis on which you pulled up my hon. Friend the Member for Leeds, Central (Mr. Fatchett). If you do this

now, you will contradict Mr. Speaker, who is your gaffer. You have to make up your mind. Will you accept Mr. Speaker's decision to allow the Minister to speak about the merits, and therefore let my hon. Friend the Member for Leeds, Central answer the Minister's case? This is a matter for you.

Mr. Deputy Speaker: The hon. Gentleman and I understand each other and what we are discussing. I certainly have regard for what he said.

Mr. Fatchett: With respect to you, Mr. Deputy Speaker, we could cite paragraph 4 of the regulations to claim that we were in order. It refers to the amount of money spent on the assisted places scheme.
I return now to the argument that is intrinsic to the nature of the regulations—the Government's willingness to spend £50 million on a handful of youngsters rather than to invest in the whole education system. Before you rightly brought me back into line, Mr. Deputy Speaker, although I did not believe that I had erred on that occasion, I was trying to make the point that, as the Parliamentary Under-Secretary of State for Education and Science, the hon. Member for Wantage (Mr. Jackson), said in a letter to my hon. Friend the Member for Blackburn (Mr. Straw), the Government are willing to spend £5,661 on assisted places in certain cases and they say that the majority of cases cost about £2,500 a year. How many local authorities are entitled to spend that amount on what are, in effect, their assisted places—the schools that the overwhelming majority of our youngsters attend? The Minister of State readily agreed that the £2,500 that ILEA and other local education authorities spend is too much for most children. Therein lies the real division between us.
We want to ensure that all our children have adequate resources, teaching and books. But the Government want to invest in a handful of children and discriminate against the vast majority of youngsters.

Mr. Dunn: What is the hon. Gentleman's knowledge of the cost to the taxpayer of each assisted place compigedt to the cost to the ratepayer of a place in inner London secondary education?

Mr. Fatchett: I said earlier that some of my hon. Friends might be prepared to have a word with the Prime Minister on the Minister's behalf, but on the basis of that intervention our case would be rather flimsy.
There is a crucial difference. The Minister's argument is an intellectual figleaf. We are talking about the investment in individual youngsters, not the individual taxpayer's contribution. Of course less is spent on the assisted places scheme than would be spent by individual local authorities, because the scheme extends to only a handful of youngsters. We are discussing the investment per child. So the Minister says that a certain level of investment in children is profligate and wrong; but he justifies it in the case of private education——

Mr. George Walden: Will the hon. Gentleman answer two brief questions, which go to the heart of the matter? First, where does the demand for assisted places come from? Why should there be demand if children and parents are satisfied with local education?
Secondly, I advise the hon. Gentleman to be careful. He is making the case for opting-out schools, which will provide a choice for local children, with no extra Government expenditure.

Mr. Fatchett: I do not see the logic of the argument for the preferential treatment of opt-out schools. We are arguing on behalf of all our children.
As for the hon. Gentleman's first point, he will recall that I said that the Government are having some difficulty finding children to fill the available assisted places.

Mr. Alan Amos: Rubbish.

Mr. Fatchett: The hon. Gentleman may say that, but the statistics do not lie: there has been a fall-off in the number of children taking up assisted places.

Mr. Martin Flannery: Some appalling figures were given in a written answer about six months ago. For instance, one school had nearly 450 assisted places out of 1,200 at a minimum of £2,000 each, which is £900,000 for that school alone. When all the money was counted, it was found that there were at least a dozen schools like that, and about 30 with between 300 and 400 assisted places. A vast amount of money is involved; it is nothing like what was said at the beginning.

Mr. Fatchett: My hon. Friend makes his point very effectively. The schools to which we refer are not private, independent schools, but schools supported by state money to maintain preference. That is what we object to.

Mr. Nicholas Bennett: rose�ž�ž

Mr. Fatchett: No, I shall not give way again.
Let me finally make clear the Labour party's position, and that of a future Labour Government. Because of the privilege and preference engendered by the assisted places scheme, because it discriminates against the many in favour of the few and because it does not invest in our children, we intend to cancel it. It has no part to play for a future Labour Government who believe in extending opportunity in education to all our children. Because of our belief in that opportunity, we oppose the regulations and the principle of the assisted places scheme.

Dame Elaine Kellett-Bowman: The hon. Member for Leeds, Central (Mr. Fatchett) said that public money was keeping private schools in operation. That is far from the case. What it does is give children who would otherwise be denied it the opportunity of the finest education that the country can offer.
We in Lancaster have been fortunate, in that we have retained our grammar schools through thick and thin and therefore have no need of the assisted places scheme. But the school that I had the honour to attend—Queen Mary's, Lytham—took children from all over the area: from every housing estate and every possible district. Once the school unfortunately went private, that was no longer the case: youngsters who had had the privilege of that education no longer received it. Now, I am thankful to say, there are 43 assisted places in Queen Mary's school, and once more those children have the opportunity of a first-class education.

Mr. Patrick Thompson: Someone like myself who has taught many people on the assisted

places scheme would agree with my hon. Friend when she says that it is the young people with parents on low incomes who gain from the scheme. That is why it has been such a success.

Dame Elaine Kellett-Bowman: Indeed. The saner part of the House cannot have failed to be impressed by the Minister's figures for those on wholly assisted places. That is the crucial figure, and I believe that his intention to expand it to 35,000—many of whom will be wholly assisted—is entirely in the interests of the children of this country. My constituents and I fully support it.

Mr. Richard Livsey: In theory, the assisted places scheme may sound reasonable; in reality, it has many weaknesses. It is important to stress that my party does not oppose private education. If people wish to spend their own money on independent schools, that is up to them. What we object to is that this form of education benefits from state money which would be better employed in the state sector——

Mr. J. F. Pawsey: Will the hon. Gentleman give way?

Mr. Livsey: Not yet. I have only just commenced my speech. I shall give way in a minute.
When the state sector is desperate for funds, as it is at present, it cannot be right to support the assisted places scheme. I understand that in 1985–86 the figure of support was £29 million, and the forecast is that in 1987–88 it will be £49 million. That increase is because, in some instances, almost twice as much is being spent per pupil on assisted places as is being spent per pupil in the state schools.

Mr. Harry Greenway: The hon. Gentleman seems to be going down the same path as the Opposition in advocating the ILEA level of spending on secondary education. Is he aware that the leader of ILEA said about the secondary school system that it had let down the children for the past 10 or 20 years? Does he advocate that in the same way that the hon. Member for Leeds, Central (Mr. Fatchett) advocates it?

Mr. Livsey: If the state sector had been properly funded during the tenure of the Conservative Government, perhaps the leader of the ILEA would not have to make such statements. The inadequacies of the state sector have come about because it has been bled of public funds, and it has suffered grievously. We should be talking about the improvement of education, particularly state education, which provides schooling for the majority of children. Almost twice as much money is spent per pupil on the assisted places scheme as is spent per pupil in the state sector.

Mr. Dunn: I am sorry to interrupt the hon. Gentleman, but he has twice said something that is incorrect. The average cost of a maintained sector secondary school place for England as a whole in the financial year 1986–87 was £1,570. The cost to the taxpayer of each assisted place in the academic year 1986–87 was £1,759. That is not twice the cost in the state sector.

Mr. Livsey: It is, none the less, more than what is being spent in the state sector. A parliamentary answer given on 26 March 1987 shows that, for example, in Harrow the


cost of an assisted place was £2,252, whereas the average cost per pupil in the state sector was only £1,200. The cost is different in different places. That is on the record.
The private sector will benefit substantially from the tax cuts given in the recent Budget to some of the richest people in our society. The state sector, rather than assisted places, should be getting the state money. Some of the best pupils are being taken out of the state sector and put into private schools, and that weakens the state sector.
Comprehensive schools are desperately short of funds, and the experience of my children in comprehensive schools has shown me that books are shared. In my local authority, spending on books is as low as £7 per pupil. It is time that the Government thought about investing in our children, because almost 90 per cent. of them are educated in the state sector.
The state cannot afford the subsidy being given through assisted places. The scheme is an anachronism. I note that the regulations try to assist those on low incomes, and that is of interest. None the less, these children are being taken out of the state sector, and as a result funds are being drained from it. The problem is that there is a danger of creating a two-tier education system through Government subsidy, and, as a matter of principle, that is not acceptable. We need to assist the majority of children in the state sector, and not a small minority, which is a highly selective system.

Mr. James Pawsey: The hon. Member for Brecon and Radnor (Mr. Livsey) will forgive me if I do not pursue him down the various paths that he was evidently signposting. On the Government side of the House we had difficulty in establishing whether the speech that he was delivering so well was his or that of the hon. Member for Yeovil (Mr. Ashdown) or, indeed, that of the hon. Member for Berwick-upon-Tweed (Mr. Beith).
I am sorry that the hon. Member for Leeds, Central (Mr. Fatchett) is not now in the Chamber. He mentioned many statistics, but he did not choose to refer to the fact that a recent poll showed that some 72 per cent. of those people consulted were in favour of this scheme going forward.
I would like to comment specifically on regulation 4, which refers to the scales of remission. Clearly, that is an important issue which affects the number of children going to assisted places schools. Undoubtedly, the scheme makes a relatively modest contribution towards increasing the amount of freedom and choice available to parents. It broadens children's horizons and enables them to share in the advantages that undoubtedly accrue from the independent sector. The scheme helps those parents who, while appreciating the benefits of independent schools, are perhaps unable to afford them. It also helps those who are less well off, single parent families and those who may be socially disadvantaged.
In a letter of 26 January to the chairman of the Incorporated Association of Preparatory Schools, my hon. Friend the Minister, who I am delighted to see in his usual place on the Treasury Bench—I have not the slightest doubt that he will grace it for many more years—said that the
Government has made a commitment in principle to a modest expansion of the scheme".

Mr. Straw: We have listened to the hon. Gentleman's generority towards the hon. Member for Dartford (Mr. Dunn). Does that mean that, if the hon. Gentleman should ever be offered the job of Parliamentary Under-Secretary of State at the Department of Education and Science, he will refuse it?

Mr. Pawsey: With the utmost respect to the hon. Gentleman, if my hon. Friend should move Departments and become a Minister of State, which is something that Opposition Members are unlikely to do—certainly in the lifetime of most hon. Members—of course, his and my promotion would be most welcome.
A modest expansion has occurred in the assisted places scheme since it was first announced in 1981. While the increase in places is to be welcomed, it has not gone far enough. One of the aims of the Education Reform Bill is to increase the amount of freedom and choice available to parents. Clearly grant-maintained schools represent a major step forward. The assisted places scheme is another facet in the drive to provide the maximum choice for parents. The scheme is clearly set out in regulation 4, but hon. Members will recall that it covers only the educational cost. The fees for boarding are carefully excluded. I wonder whether there is now an argument for re-examining this part of the scheme.
Much of the benefit to be derived by youngsters in the independent sector is from boarding and, as the majority of schools are geared to the needs of the majority of pupils who enjoy the benefits of boarding, day boys may miss out.
Moreover, many youngsters will attend school until the late evening, which will present some difficulties for parents collecting them and returning them to school the next day, especially if the schools are some distance from home. Geography restricts choice.
I was disappointed to see that the regulations do not refer to children from the ethnic minorities. I suspect that the majority of children who take advantage of the assisted places scheme are white. Does my hon Friend intend to broaden the scope of the scheme and to improve the publicity so that we may attract more Asian and West Indian children to participate in the scheme?
It is not surprising that the scheme attracts considerable interest among a wide range of independent schools. When it was introduced, some schools were suspicious about it, but those suspicions have been dissipated. The more schools come forward, the better.
In a letter dated 6 June my hon. Friend the Minister advises that there has been a substantial response to the invitation, issued to independent schools at the turn of the year, to participate in the scheme. Each application is considered in detail against a background of rigorous criteria which ensure that the quality of participating schools remains uniformly high.
Will my hon. Friend the Minister consider extending the scheme to younger children and preparatory schools? A substantial number of parents clearly believe that the education offered in the independent sector at an early age is worth paying for and worth making substantial sacrifices for. They believe that such schools offer a substantial advantage.
I would like there to be a modest expansion in both the number of overall places and in the age range, assisted places being provided for younger children in preparatory schools. I should like my hon. Friend to reconsider the


possibility of funding part of the boarding cost, and I hope that he will consider means of ensuring that we get more participation by both West Indians and Asian children.

Mr. Martin Flannery: The hon. Member for Rugby and Kenilworth (Mr. Pawsey) took a broad sweep which went miles beyond the regulations. He spoke of advertising and involving more people. I fully understand why. I do not agree with him, but it is impossible not to take such a broad approach.
We shall get rid of the assisted places scheme as soon as we are returned to office as it is now an expensive and fundamental part of private education. These proposals will merely intensify that fact. Public money taken from the state sector, which has suffered endless cuts, is being given to private education, not to help poor children but to expand the private sector in opposition to the public sector.

Mr. Patrick Thompson: Will the hon. Gentleman give way?

Mr. Flannery: Not just now. Let me get on a bit and then we shall see. If the hon. Gentleman is not a good boy, I shall not let him in at all—and that goes for all Conservative Members.
The harsh reality is that more and more amendments will he necessary to siphon more money from the ratepayers—including poor ratepayers—so that the children can go to school in that sector. Regulation 12 of the main regulations states:
The parents of an assisted pupil shall not be entitled to any remission of fees for which they are liable in respect of a period before the pupil took up his assisted place or (in lieu of notice or otherwise) after he has left the school, or if he so remains at the school, after the end of the school year in which he obtains the age of 20 years.
The statutory age for the vast majority of our children is 16 years, yet this regulation talks about an age of 20 years. I do not know what kind of pupil that is. The age is being amended to a slightly younger age.
The money from ratepayers, many of whom are poverty-stricken, is being siphoned off to send as many as 450 of the 1,200 children to one school. That is over one third, so we should be clear about what is being amended.

Mr. Thompson: Will the hon. Gentleman give way?

Mr. Flannery: I shall not give way just now.
Over one third of the pupils in those schools are being paid for by public money. That is what the measure is about. Conservative Members are defending siphoning off money from the poor for middle-class children, saying that they are poor. The Government are using public money to let children go to those shcools who already have plenty of money to go to the private sector if they want to do so.

Mr. Thompson: Will the hon. Gentleman give way?

Mr. Flannery: I am sure that the hon. Gentleman will make his own speech. He can stand up to speak, just as I did.
In the Newcastle-under-Lyme school to which I referred earlier, more than 450 of the 1,200 children are on assisted places. That accounts for almost £1 million a year for one school alone. The Minister gave the figures, but, of course, he cheated when he said £1,700. He knows that £1,700 is an average and does not take many other things

into account. He gave that figure so that people would not see the reality because, in many of these schools, the fee paid is £2,500, not £1,700. That figure was given in an answer by the Minister. The hon. Member for Brecon and Radnor (Mr. Livsey) has a copy of it, which I have just consulted and which I have quoted on many previous occasions.
Many schools are now involved and the amount of money being paid out is £27,000, at an average of well over £2,000 each. The total is at least £54 million at present. The Minister says that the figure will go up to £35,000. Does anyone think that it will remain at £35,000 when, six months ago, 30 more schools were wanting to get on to this education gravy train?
The figure will not remain at £70 million.

Mr. Thompson: Will the hon. Gentleman give way?

Mr. Flannery: I shall give way in a moment, if the ho n. Gentleman will let me finish this point.
Seventy million pounds of public money is now about to be expended, and we know what will happen. As soon as another 30 schools leap on the gravy train, the figure will move up to £100 million, taken out of the state sector and given to rich schools.

Mr. Thompson: The hon. Gentleman is——

Mr. Flannery: The hon. Gentleman should say that he is grateful.

Mr. Thompson: I am most grateful to the hon. Gentleman for giving way. He was talking about expansion of the independent sector. If it is to expand, that will remove a burden from the state sector, which means that there will be more funds available for it. If there are more assisted places, that will have the same effect. The hon. Gentleman's argument is wrong.

Mr. Flannery: The hon. Gentleman is so lyrical that we could almost set his comments to music. The harsh reality is that our money is being taken away from us to shore up an already flourishing private sector. We shall get rid of it as soon as we can—[HON. MEMBERS: "Oh".]—and tonight, with the utmost determination, we shall vote against the wickedness that takes money away from poor children so that it can be given to rich schools.

Mr. Nicholas Bennett: The hon. Member for Sheffield, Hillsborough (Mr. Flannery) talked of a wicked system that takes money away from poor children. But it gives money to poor children. The assisted places scheme was set up to help those from families on low incomes who deserved to receive the best possible education and the choice that was available in other areas but not in theirs.
The hon. Gentleman is a member of a party which for years has squawked about the fact that only 6 or 7 per cent. of our children are able to attend independent schools. Yet here is an opportunity for more children to go to such schools, and the hon. Gentleman is opposed to it. He is opposed to private education in principle, and that is what it is all about. He did not talk about the rights of parents to choose their children's schools and the education that they should have. We are talking about a modest scheme which provides an opportunity for those who would not


necessarily have the chance to obtain the education that their parents wish for them. I welcome the intentions behind the regulations.

Mr. Fatchett: Has the hon. Gentleman seen the research by Mike Douse which was published in Educational Studies? It is entitled "The Background of Assisted Places Scheme Students". It arrived at two conclusions which I shall draw to the hon. Gentleman's attention. First,
relatively few APS students come from unambiguously working-class backgrounds.
Secondly,
many APS students are drawn from families already within the 'Independent School frame of reference'.
Thus both his major conclusions run against and vitiate the assertions that the hon. Gentleman is making. The arguments of my hon. Friend the Member for Sheffield, Hillsborough (Mr. Flannery) are substantiated by independent research and do not depend on the prejudices that the hon. Gentleman is trying to peddle.

Mr. Bennett: I should be interested to know exactly who the survey was commissioned by and exactly who the gentleman who produced it is. I am interested to know what an unambiguous working-class background is. That is a strange description. Perhaps the hon. Member for Oldham, West (Mr. Meacher) comes within that category. Under this Government, the number of those who describe themselves as working class has been declining as the middle class expands due to tax cuts and increased prosperity.
The assisted places scheme defines by income, and those with large incomes are not allowed to participate in it. We know that those who have been taking advantage of it are, for example, the sons of policemen, the sons of shopkeepers and the sons of shop stewards. Ordinary people have been given back the opportunity which was removed from them in 1976 when the Labour Government abolished the direct grant schools. The schools that have the largest percentages of children on assisted places are former direct grant schools that provided free education for such children under state provision until the Labour Government abolished it. Labour Members should remember that when they discuss the regulations.
The hon. Member for Brecon and Radnor (Mr. Livsey) is a near neighbour of mine in parliamentary terms. realise that he was trying to read the handwriting of the hon. Member for Yeovil (Mr. Ashdown). That accounted for his halting delivery and the doubtful philosophy that lay behind his speech. It is strange that the party which until recently called itself the Liberal party, and which still has Liberal in its title, should oppose a scheme which encourages diversity and the variety of education which was a fundamental philosophy of John Stuart Mill and the Liberal party until very recently.

Mr. Deputy Speaker: Order. That is all very interesting but it has little to do with the regulations that are before the House.

Mr. Bennett: I shall try to follow your injunction, Mr. Deputy Speaker, but the hon. Member for Brecon and Radnor appears to have left his philosophy and his principles behind along with the rest of the Liberal party, when it decamped.
The hon. Member for Leeds, Central (Mr. Fatchett) made the peculiar argument that, because people will receive state funds in assisting their children to attend independent schools, those schools will cease to be independent. On that logic, if anybody spends any part of their supplementary benefit or income support, or has a local authority bus pass to use public or private transport, the object of that expenditure or assistance will cease to enjoy its independence. That would also be true of universities, which, we are proud to say, are independent.
It is nonsense to believe that, because the state is prepared to assist people with funding, it will dilute the independence of the institution concerned. That underlines the Labour party's nonsensical opposition. It does not believe in freedom of choice, in diversity of education, or in competing standards of quality. Labour Members want a grey, uniform system in which our young people will be forced to attend the neighbourhood comprehensive, on which the Labour party will impose its standards, rather than allow anybody to have a choice. I applaud the Government for sticking to their principles.

Ms. Hilary Armstrong: We are having an interesting debate and one that, in many respects, goes to the heart of all the education debates of the past month. Tonight's discussion centres on certain narrow powers, and it appears that the Government have created for themselves a number of problems. Perhaps the Minister, when he replies, will be able to provide solutions to them.
Government Members claim that the regulations are intended to permit access by the widest possible range of children— although the number will be small—to the best possible education. However, that education—even on the Minister's lowest average estimate, including a parental contribution—will cost substantially more than in the state sector. Yet the Government have tried to tell us, week after week, month after month, that resources are not a problem in the state sector.
We have been arguing for many a month, and many a year, that the Government ought to be putting far greater resources into the state sector to improve the quality of education and the opportunities there for all children, and to meet the aspirations and wishes of the parents, about whom the Government say that they are so concerned. How will the Government reconcile that contradiction? They say, "The state sector is spending far too much and we shall have to cut back the amount of money going into those schools. On the other hand, because we're interested in providing a good education for these few children, we'll spend more public money to support a small number of places at much higher cost."
The second problem that Conservative Members have highlighted tonight is that the Government are trying to justify the public sector supporting independent schools. The hon. Member for Pembroke (Mr. Bennett) made that point very forcefully. If that is so, and if the hon. Gentleman is right in saying that the public purse ought to be spent in that way, how can the Government justify having the House work through the Education Reform Bill in the way that it has? How do the Government justify such children being completely outside the national curriculum? The Government are simply not prepared to face up to that contradiction.
I could talk about many other contradictions that are inherent in the Government's case, but those two alone give the lie to the Government's claim that the regulations extend choice.
In my county of Durham there are no assisted places, but there are many young people who are attending school day by day who have the right to, and we have the duty to offer to them, the very best. It is no good the Government saying that their answer to that is to enable a few to enter the independent sector.
The Government need to examine the independent sector and ensure that it provides the quality that it claims to provide. If one looks at such narrow qualifications as exam results, many of those schools simply do not come up to the level of many of our state schools.
If we are really talking about extending choice and opening up opportunities, the Government have to take on board the fact that, instead of dealing in this marginal and elitist way with a few children, they must address the needs of all our children. The children in Durham are just as important to Britain's future as the children in Surrey. The Government cannot get away with constantly discussing the quality of education when they are only addressing the needs of a few of our children.
If the Government are really interested in extending choice and ensuring that parents feel that their children have the best, they will begin to put into the state sector the resources that they know that it needs and without which it cannot survive.
The state sector, used by 92 per cent. of our children, is being starved of the resources that it needs to provide those opportunities and that choice. The Government are failing that 92 per cent. of the population of school age children when they address themselves to regulations such as these and not to the needs of the children and the needs of our state schools.

Mr. Bob Cryer: It is important to say a few words about the assisted places scheme and the regulations which modify the principal regulations in determining the eligibility of youngsters to qualify under the scheme.
First, parents who are seeking the best education for their children would be well advised to send them to co-educational comprehensive schools because that system has been tried and tested and, despite attacks by politically motivated groups, mostly from the Conservative party, on the figures provided by the Department of Education and Science, in academic terms, which are generally the only terms looked at by Conservative Members, the number of passes at 0 and A-level per thousand children has steadily increased throughout the past quarter of a century when comprehensive education has changed from being a derided experiment into an accepted and, indeed, preferential choice for most parents.
Many of us remember the time of the 11-plus and the discrimination between those who passed and those who did not. Many of us resented the snobbery and discrimination which accompanied that. I can well remember as a young lad at primary school getting involved in fights with other youngsters about who went to which school. Because I happened to pass the 11-plus and went to a grammer school I was called a snob-school snob by children from the same street in which I lived because

of the snobbery endemic in that system. Our children went to comprehensive co-educational schools and we blessed the day that the Labour movement pressed for those schools to be instituted because my wife and I knew that our children were never subject to the discrimination and pressure that we had to suffer when we were at school.
It is important to emphasise comprehensive co-education. Of course, it will always seek to improve standards of attainment, but it still represents an important principle with a high standard of application.

Mr. Pawsey: Will the hon. Gentleman say something about parental choice? Does he accept that parents should have the opportunity to send their children to alternative schools? Does he agree that the idea of CTCs is a good one? Does he agree that areas that maintain grammer schools do so because parents wish to retain them? Does he agree that comprehensive schools may have some of the answers, but they do not have all the answers? In the regulations, as in the Education Reform Bill, we are seeking to broaden parental choice. Will he address his mind to that?

Mr. Cryer: I shall certainly address my mind to that point. I shall not spend time on CTCs as the DES is wasting money on CTCs which are not covered by the regulations and no doubt you, Mr. Deputy Speaker, would pull me up if I dwelt on that subject. Suffice it to say that the £30,000 that the Government gave to Bradford chamber of commerce to investigate a CTC in Bradford was money frivolously and wastefully thrown away in an outrageous use of taxpayers' money. I am surprised and startled that more Conservative Back Benchers have not been a little more critical about such misuse of taxpayers' money.
As for choice, the Education Act 1944 was introduced by R. A. Butler, a man who once found favour in the Conservative party. He would have no place in the Government of today, because he was too progressive, too much part of the old, one-nation section of the Conservative party, but his Education Act 1944 was generally regarded as a progressive measure at that time.
The Education Act 1944 was interpreted in various court decisions, and the Conservative party generally supported the judiciary view that the choice for parents must always be interpreted as being measured within the framework of the facilities which a local authority can provide. That is not absolute; it is a qualified choice. The hon. Member for Rugby and Kenilworth (Mr. Pawsey), representing the Right-wing, rabid section of the Tory party, said that the middle class was expanding. Those articulate, middle-class parents should be arguing for improvements in the state sector of education so that the choice within the state sector is more meaningful, and not making such arbitary discrimination.
The hon. Member for Rugby and Kenilworth suggested that the children who were the subject of the regulations deserve to get the best possible education. I thought that all our children deserved the best possible education. The argument that Conservative Members are putting forward is that a certain section of the population—clearly not all the population, because only a minority will come under the assisted places scheme, which is expensive enough at a total cost of £50 million—will be subject to the regulations.
Some parents may consider that, in academic terms, private education is the best possible education. But there


is no doubt that some parents will regard it purely in terms of the snob value and the position in society which is reflected by their child going to an independent school. Many people in that position send their children to such schools not for the education they get but because of the cap and uniform they wear. They think they have got in with the posh people.
I hear Conservative Members trying to chide me about having gone to a grammar school. I went to that school because it was part of the system that operated at that time and, being 11, I did not have much choice. Like all children in the area, I had to take the 11-plus. Like some, I passed, but the majority failed. I objected to that system then——

Mr. Nicholas Winterton: When?

Mr. Cryer: I argued about it at the time, from 11 onwards, when I got to grammar school. [Interruption] Some of us had political leanings at a very early age and some of the fights in which I was involved as a young kid, in which bricks were thrown between gangs, taught me that snobbery and discrimination exercised among young children produced bad results among those children. Today, the Tory Government are bringing into the 1980s the sort of divide that existed in the 1940s.
When earlier I criticised the hon. Member for Lancaster (Mrs. Kellett-Bowman) over her two minutes or so of platitudes, some of her hon. Friends seemed to express regret about my not having addressed the House on this matter. I am making good that omission now, and I have not finished yet.
There are two elements in the sort of discrimination we are discussing. One is snobbery and the other is the development of a meritocracy; IQ plus effort equals merit. The famous book of the 1950s, "The Rise of the Meritocracy", has largely been discredited on the basis that to pluck a tiny section out of society and provide it with a privileged education is wrong.
My hon. Friends and I argue—and the Conservatives argue when they are looking for votes—that people should have the same opportunities. But here the Government are deliberately plucking out a section of society and providing it with a privileged, what they regard as a better, education, though I dispute that it is better.
I shall contrast the attitude of Ministers as they lavish £50 million on this scheme with their attitude to the situation in, say, my constituency, where, in the state sector, Bradford has urged the Government to spend more to replace some of the 500 temporary classrooms that are in use in the area. These temporary classrooms have been in use so long that some money that has been allocated for permanent buildings is having to be used to repair them, thus preventing the local authority from spending the money on the permanent extensions that are badly needed. The Department of Education and Science says that there is not sufficient money to provide more permanent classrooms in Bradford. Schools cannot be provided with adequate playing space. In schools in Queensbury in my constituency——

Mr. Deputy Speaker: Order. The hon. Gentleman knows that these regulations are not an appropriate peg on which to hang a discussion on the state of education in Bradford.

Mr. Cryer: "Erskine May" is quite specific that one is allowed to give passing illustrations by way of explanation, and I am doing that. I could do it a great deal more quickly if I could get to the end of it, but I am sure your guidance is very helpful, Mr. Deputy Speaker.
The regulations are costing taxpayers money. They modify the whole of the regulations under which children are determined as being eligible or otherwise for the assisted places scheme. The total cost of that scheme is about £50 million. These regulations are misplaced, because there are more urgent priorities for the money that is being allocated. I am saying by way of explanation that in some schools in Bradford there are many temporary classrooms that need replacing by permanent accommodation and that the education authority is having to build outside toilets to cater for the classrooms which are outside the permanent accommodation because the Department of Education will not provide the money for such accommodation in the state sector.
It will shock you, Mr. Deputy Speaker, as much as it shocks me that the Government are prepared to lavish £50 million on a scheme that bolsters the private sector. The truth is that when the assisted places scheme was originally introduced the private sector was withering, and it was a shot in the arm by the taxpayer that kept it from withering away. The Government are now giving more money to bolster inequality and snobbery and allowing the state sector, which deals with 92 per cent. of our children, to wither away, as a deliberate act of vengeful policy against the majority of the people. I am sure that these arguments will get home by the next general election and that the Government will rue their actions today.

Mr. Fatchett: rose——

Mr. Deputy Speaker: Has the hon. Gentleman the leave of the House to speak again?

Mr. Fatchett: With permission, Mr. Deputy Speaker, may I say that we have had a lively debate which has shown some of the key divisions in education provision. My hon. Friends the Members for Sheffield, Hillsborough (Mr. Flannery), Durham, North-West (Ms. Armstrong) and Bradford, South (Mr. Cryer) have made a strong argument against the privilege that is implied and enacted by these regulations.
The only thing said by my hon. Friend the Member for Bradford, South with which I disagree is that Tory Members had to wait until they came to this place for some political education. It seems to me that the only political education that Conservative Members need is enough to enable them to find their way faithfully into the appropriate Lobby without much thought.
There have been two key arguments in the debate. The first concern the nature of the so-called private independent sector. Not one Conservative Member has been able to substantiate the argument that we have a private independent sector. They know that the schools in that sector are supported by the taxpayer. As my hon. Friends have said, that intervention has kept the schools alive; without it, they would not exist in their present form. They are not private schools; they are state-subsidised schools and should be recognised as such. The argument that we have heard so often from Conservative Members that the national curriculum should not apply to the


independent sector has been shown to be very thin indeed because we now know the true nature of that independence.
The other argument that Conservative Members have advanced is that the scheme and the regulations provide for opportunity. That is a very interesting argument. We need to remember the Government's record, and their reluctance to invest in education for all our children. If Conservative Members propose to tell us about opportunity, they should tell us about opportunity for each and every one of our children. As my hon. Friend the Member for Bradford, South and others have said, the simple fact is that the Government have decreased spending per child by 20 per cent. in real terms during their lifetime.

Mr. Key: Not true.

Mr. Fatchett: It is true.
That is the extent to which the Government believe in equality of opportunity. If their words were true, and if their acts followed their words, the Government would make the money for the scheme and the money that they are wasting on city technology colleges available for all our children. They would invest in the education of all our children. Their ideology—their commitment to a few and to privilege—stops them doing that. That is why Opposition Members oppose the scheme, and why we shall vote against the regulations tonight.

Mr. Dunn: This debate has become an annual event for me. I welcome it because it enables me to show clearly the support of the Government and my hon. Friends for the scheme. It also enables Opposition parties to exercise their prejudice against parental choice. The Opposition do not give a fig for parental choice.
In a speech that I found incredible, both in its arguments and in its lack of focus, the hon. Member for Bradford, South (Mr. Cryer) quoted R. A. Butler, a man highly esteemed in our party for his part in the enactment of the Education Act 1944. I remind the hon. Gentleman that R. A. Butler believed in the tripartite system of secondary provision—the grammar schools, the technical grammar schools and the secondary modern schools.

Mr. Straw: Will the Minister give way?

Mr. Dunn: In one moment.
The hon. Member for Bradford, South went on to talk about his experiences as a child in a working class community. I know all about that, too. He spoke about Bradford and its needs. I remind the House that there was a by-election victory in Bradford only a few days ago in which we took a seat from the Labour party with a massive swing and a greater majority than might have been expected; so much for our policies and the lives of the people of Bradford. The hon. Member for Bradford, South does not understand——

Mr. Straw: Will the hon. Gentleman give way?

Mr. Dunn: I shall give way in a moment— [HON. MEMBERS: "Give way."] No. I must make this point. This has to be placed on the record.
The Labour party has never understood the aspirations of ordinary families. What it forgets is that when a working class child received a place at a grammar school,

it was a matter of pride for the whole community. It was never even a matter for contempt or for the anguish described by the hon. Member for Bradford, South—whom I do not see in the Chamber, incidentally

Mr. Cryer: On a point of order——

Mr. Dunn: Surely the whole point——

Mr. Cryer: On a point of order——

Mr. Dunn: I am enjoying myself too much to give way, Mr. Deputy Speaker.

Mr. Cryer: On a point of order, Mr. Deputy Speaker. The Minister is clearly politically blind and apparently physically blind. I have been sitting in the Chamber the whole time, but he has not been able to see me. I want to make it clear that I am here.

Mr. Dunn: I apologise to the hon. Gentleman. He merges into the background every time that I try to see him.
The hon. Member for Brecon and Radnor (Mr. Livsey), in an unusual speech which it is worth reading, said that under the scheme the brightest children from state schools are taken out of the state system and placed in the independent schools almost by force. That is totally untrue. Because of parents' aspirations, those children ultimately find their way into independent schools. I must remind the House—

Mr. Straw: Will the hon. Gentleman give way?

Mr. Dunn: I have changed my mind.
A survey conducted in 1976 showed that 72 per cent. of the public approved of the assisted places scheme.

Mr. Straw: Will the hon. Gentleman give way?

Mr. Dunn: I will not give way.
When broken down by voting intention, support for the scheme was as follows: 86 per cent. of Conservative voters, 74 per cent. of SDP voters, alliance voters or whatever they are called, and 60 per cent. of Labour voters were in favour of the scheme, and 70 per cent. of trade unionists expressed approval. We do not need the Labour party's support when we have the people's support. I commend the regulations to the House.

Question put:—

The House divided: Ayes 186, Noes 128.

Division No. 397]
[11.46 pm


AYES


Aitken, Jonathan
Bowis, John


Alexander, Richard
Brandon-Bravo, Martin


Allason, Rupert
Brazier, Julian


Amess, David
Brooke, Rt Hon Peter


Amos, Alan
Brown, Michael (Brigg amp; Cl't's)


Arbuthnot, James
Browne, John (Winchester)


Arnold, Jacques (Gravesham)
Buck, Sir Antony


Ashby, David
Burns, Simon


Atkinson, David
Burt, Alistair


Baker, Nicholas (Dorset N)
Butcher, John


Baldry, Tony
Butler, Chris


Batiste, Spencer
Carlisle, John, (Luton N)


Bellingham, Henry
Carlisle, Kenneth (Lincoln)


Bennett, Nicholas (Pembroke)
Carrington, Matthew


Benyon, W.
Carttiss, Michael


Bevan, David Gilroy
Cash, William


Blackburn, Dr John G.
Chalker, Rt Hon Mrs Lynda


Bonsor, Sir Nicholas
Chapman, Sydney


Boscawen, Hon Robert
Chope, Christopher


Boswell, Tim
Churchill, Mr






Clarke, Rt Hon K. (Rushcliffe)
Nelson, Anthony


Conway, Derek
Neubert, Michael


Coombs, Anthony (Wyre F'rest)
Nicholls, Patrick


Cope, Rt Hon John
Nicholson, David (Taunton)


Couchman, James
Parkinson, Rt Hon Cecil


Cran, James
Patnick, Irvine


Davies, Q. (Stamf'd amp; Spald'g)
Patten, John (Oxford W)


Davis, David (Boothferry)
Pawsey, James


Day, Stephen
Porter, David (Waveney)


Dickens, Geoffrey
Price, Sir David


Dorrell, Stephen
Raffan, Keith


Dunn, Bob
Raison, Rt Hon Timothy


Dykes, Hugh
Rathbone, Tim


Emery, Sir Peter
Redwood, John


Evans, David (Welwyn Hatf'd)
Renton, Tim


Evennett, David
Riddick, Graham


Fallon, Michael
Roberts, Wyn (Conwy)


Farr, Sir John
Roe, Mrs Marion


Favell, Tony
Rumbold, Mrs Angela


Field, Barry (Isle of Wight)
Ryder, Richard


Forman, Nigel
Sackville, Hon Tom


Forsyth, Michael (Stirling)
Sayeed, Jonathan


Forth, Eric
Shaw, David (Dover)


Fox, Sir Marcus
Shaw, Sir Michael (Scarb')


Franks, Cecil
Shephard, Mrs G. (Norfolk SW)


Freeman, Roger
Shepherd, Colin (Hereford)


French, Douglas
Sims, Roger


Gale, Roger
Smith, Sir Dudley (Warwick)


Garel-Jones, Tristan
Smith, Tim (Beaconsfield)


Gill, Christopher
Speller, Tony


Goodson-Wickes, Dr Charles
Spicer, Sir Jim (Dorset W)


Gorman, Mrs Teresa
Spicer, Michael (S Worcs)


Gow, Ian
Squire, Robin


Greenway, John (Ryedale)
Stanbrook, Ivor


Griffiths, Sir Eldon (Bury St E')
Stern, Michael


Griffiths, Peter (Portsmouth N)
Stewart, Allan (Eastwood)


Gummer, Rt Hon John Selwyn
Stewart, Andy (Sherwood)


Hamilton, Hon Archie (Epsom)
Stokes, Sir John


Hamilton, Neil (Tatton)
Stradling Thomas, Sir John


Hanley, Jeremy
Sumberg, David


Hannam, John
Summerson, Hugo


Hargreaves, A. (B'ham H'll Gr')
Taylor, Ian (Esher)


Hargreaves, Ken (Hyndburn)
Taylor, John M (Solihull)


Harris, David
Taylor, Teddy (S'end E)


Haselhurst, Alan
Tebbit, Rt Hon Norman


Hawkins, Christopher
Temple-Morris, Peter


Hayhoe, Rt Hon Sir Barney
Thompson, D. (Calder Valley)


Hayward, Robert
Thompson, Patrick (Norwich N)


Heathcoat-Amory, David
Thorne, Neil


Heddle, John
Thornton, Malcolm


Higgins, Rt Hon Terence L.
Thurnham, Peter


Hind, Kenneth
Townend, John (Bridlington)


Holt, Richard
Tracey, Richard


Howard, Michael
Trippier, David


Howarth, Alan (Strat'd-on-A)
Twinn, Dr Ian


Howarth, G. (Cannock amp; B'wd)
Viggers, Peter


Hunt, David (Wirral W)
Waddington, Rt Hon David


Hunt, John (Ravensbourne)
Walden, George


Hunter, Andrew
Waller, Gary


Hurd, Rt Hon Douglas
Ward, John


Irvine, Michael
Wardle, Charles (Bexhill)


Jack, Michael
Watts, John


Janman, Tim
Wells, Bowen


Johnson Smith, Sir Geoffrey
Wheeler, John


Jones, Gwilym (Cardiff N)
Widdecombe, Ann


Jones, Robert B (Herts W)
Wiggin, Jerry


Jopling, Rt Hon Michael
Wilkinson, John


Kellett-Bowman, Dame Elaine
Winterton, Mrs Ann


Key, Robert
Winterton, Nicholas


Knight, Dame Jill (Edgbaston)
Wood, Timothy


Lennox-Boyd, Hon Mark
Woodcock, Mike


Lloyd, Peter (Fareham)



Maclean, David
Tellers for the Ayes:


Maude, Hon Francis
Mr. Tony Durant and


Neale, Gerrard
Mr. David Liehtbown.





NOES


Abbott, Ms Diane
Jones, Martyn (Clwyd S W)


Alton, David
Leadbitter, Ted


Anderson, Donald
Lewis, Terry


Armstrong, Hilary
Livsey, Richard


Barnes, Harry (Derbyshire NE)
Lloyd, Tony (Stretford)


Barron, Kevin
Lofthouse, Geoffrey


Battle, John
McAllion, John


Beckett, Margaret
McAvoy, Thomas


Bennett, A. F. (D'nt'n amp; R'dish)
Macdonald, Calum A.


Bermingham, Gerald
McGrady, Eddie


Boyes, Roland
McKay, Allen (Barnsley West)


Bradley, Keith
McKelvey, William


Brown, Gordon (D'mline E)
McWilliam, John


Brown, Nicholas (Newcastle E)
Madden, Max


Brown, Ron (Edinburgh Leith)
Mahon, Mrs Alice


Buckley, George J.
Marek, Dr John


Caborn, Richard
Marshall, David (Shettleston)


Callaghan, Jim
Marshall, Jim (Leicester S)


Campbell, Menzies (Fife NE)
Martin, Michael J. (Springburn)


Campbell, Ron (Blyth Valley)
Martlew, Eric


Campbell-Savours, D. N.
Meale, Alan


Clarke, Tom (Monklands W)
Michael, Alun


Clay, Bob
Michie, Bill (Sheffield Heeley)


Clelland, David
Millan, Rt Hon Bruce


Clwyd, Mrs Ann
Moonie, Dr Lewis


Cohen, Harry
Morgan, Rhodri


Cook, Robin (Livingston)
Morley, Elliott


Crowther, Stan
Mowlam, Marjorie


Cryer, Bob
Mullin, Chris


Cummings, John
Murphy, Paul


Cunliffe, Lawrence
Nellist, Dave


Dalyell, Tarn
O'Brien, William


Davis, Terry (B'ham Hodge H'l)
O'Neill, Martin


Dewar, Donald
Patchett, Terry


Dixon, Don
Powell, Ray (Ogmore)


Dobson, Frank
Prescott, John


Doran, Frank
Redmond, Martin


Dunnachie, Jimmy
Robertson, George


Eadie, Alexander
Rooker, Jeff


Fatchett, Derek
Ruddock, Joan


Field, Frank (Birkenhead)
Salmond, Alex


Fields, Terry (L'pool B G'n)
Sheerman, Barry


Flannery, Martin
Shore, Rt Hon Peter


Foster, Derek
Short, Clare


Fyfe, Maria
Skinner, Dennis


Galbraith, Sam
Smith, Andrew (Oxford E)


Galloway, George
Smith, C. (Isl'ton amp; F'bury)


George, Bruce
Spearing, Nigel


Godman, Dr Norman A.
Steinberg, Gerry


Golding, Mrs Llin
Straw, Jack


Gordon, Mildred
Taylor, Mrs Ann (Dewsbury)


Graham, Thomas
Turner, Dennis


Grocott, Bruce
Wall, Pat


Hardy, Peter
Warden, Gareth (Gower)


Henderson, Doug
Wareing, Robert N.


Hinchliffe, David
Welsh, Michael (Doncaster N)


Hogg, N. (C'nauld amp; Kilsyth)
Williams, Rt Hon Alan


Home Robertson, John
Williams, Alan W. (Carm'then)


Hood, Jimmy
Winnick, David


Howarth, George (Knowsley N)
Wise, Mrs Audrey


Hoyle, Doug
Worthington, Tony


Hughes, John (Coventry NE)
Wray, Jimmy


Hughes, Robert (Aberdeen N)



Hughes, Sean (Knowsley S)
Tellers for the Noes:


Illsley, Eric
Mr. Frank Haynes and


Ingram, Adam
Mr. Allen Adams.

Question accordingly agreed to.

Resolved,
That the draft Education (Assisted Places) (Amendment) Regulations 1988, which were laid before this House on 13th June, be approved.

Northern Ireland (Sex Discrimination)

The Parliamentary Under-Secretary of State for Northern Ireland (Mr. Peter Viggers): I beg to move,
That the draft Sex Discrimination (Northern Ireland) Order 1988, which was laid before this House on 17th May, be approved.
The order has several key objectives. The first and most important is to further promote equal opportunities in employment between men and women. The second is to achieve that aim in a manner that reduces unnecessary bureaucracy. The third is to put Northern Ireland on the same footing as the rest of the United Kingdom in this part of the law.
The order contains provisions analogous to those enacted in Great Britain by the Sex Discrimination Act 1986. Together with articles 7 to 10, which replicate changes introduced in Great Britain in 1976 subsequent to the enactment of the Sex Discrimination (Northern Ireland) Order of that year, the provisions will bring Northern Ireland law into line with that of Great Britain. The order is a positive measure, and reflects the Government's policy of ensuring parity of provision throughout the United Kingdom in the promotion of equality of opportunity between the sexes.
Northern Ireland has its own separate legislation and administrative framework for the promotion of equality of opportunity between the sexes and the control of unlawful sex discrimination. In reality, however, the law in Northern Ireland has tended to mirror that in Great Britain. That is hardly surprising, as much of the provision is rooted in our obligations as a member of the European Community, which bite as much in Northern Ireland as elsewhere in the kingdom. Similarly, the issues addressed in the Sex Discrimination Act 1975 and the Sex Discrimination (Northern Ireland) Order 1976, and in subsequent measures in this sector, are common to Great Britain and to Northern Ireland. It is clearly sensible, therefore, for there to be parity of provision between Northern Ireland and Great Britain and this is what this order is designed to achieve.
A number of the changes in the order, in particular articles 3 and 11 and articles 4 and 5, have been the subject of separate consultations, which paralleled similar consultations in Great Britain. The totality of the order has also been the subject of consultation as part of the normal legislative arrangements for Northern Ireland legislation of this type. I am grateful to all of those who have offered comments, even if it was not possible to accept all the points that were made.
Before dealing with the substance of each article, I remind the House that articles 3 and 11 and articles 4 and 5 stem from separate judgments of the European Court of Justice and are designed to meet the court's ruling that, on the issues concerned, the United Kingdom sex discrimination legislation—that is, the Sex Discrimination Act 1975 and, by extension, the Sex Discrimination (Northern Ireland) Order 1976—did not fully meet the requirements of the European Community equal treatment directive.
Articles 3 and 11 are a direct response to the court's concern that the 1976 order was deficient on three counts covering, first, exemption of private households, secondly, of small firms with five or fewer employees, and, thirdly, its application to collective agreements and the rules of

undertakings and of independent professions and occupations. Articles 4 and 5, on the other hand, reflect the court's ruling in the case of Marshall ν South West Hampshire area health authority in February 1986 that the dismissal of a woman solely because she had reached state pensionable age where that was different for women and men was contrary to article 5(1) of the equal treatment directive.
I shall now deal with the substance of the various articles. Articles 1 and 2 are self-explanatory and deal with the title, commencement and interpretation of terms used in the order. Article 3 repeals article 8(3) of the 1976 order, which exempts private households and businesses with five or fewer employees from the requirement not to discriminate in employment and replaces it with a more limited exception for private households.
Article 3 makes the further change of removing the exemption for small firms—that is, firms with five or fewer employees. I would add that, following the suggestion in another place during the passage of the 1986 Act, partnerships consisting of five or fewer persons were brought within the scope of the sex discrimination legislation. This was a logical extension which reflected the increase in the number of women entering business on their own account and the Government's commitment to self-employment. This provision has been replicated in full in the draft order.
Articles 4 and 5 provide for equal treatment in retirement age and are a consequence of the European Court judgment in the Marshall case, to which I have already referred. Again, the articles mirror provisions which were introduced into the 1986 Act in Committee. Employers will have up to six months to rearrange their procedures and adjust their personnel planning to comply with the new provisions, but I would hope that employers in Northern Ireland will implement these changes as quickly as possible.
Article 6 removes the administrative hurdle of designation by the Department of Economic Development which previously faced organisations wishing to provide training for people of one sex in occupations where they are seriously under-represented or to help them return to the labour market after a period of domestic or family responsibilities.
The aim of any codes issued by the Northern Ireland commission, referred to in articles 7 to 10, as with its Great Britain counterpart, will be to give practical guidance aimed at eliminating discrimination and promoting equality of opportunity: The Equal Opportunities Commission (Northern Ireland) already publishes a range of booklets of high quality. I understand that its booklet on sexual harassment is a model and has been used in Great Britain. The codes that it will now be able to bring forward will be admissible as evidence before an industrial tribunal and can be taken into account by a tribunal in deciding whether an act of unlawful discrimination has taken place. They will, therefore, be an important reference point for employers, trade unionists and individuals in understanding their rights and responsibilities under sex discrimination legislation.
Article 8 specifies a new requirement which the Equal Opportunities Commission must fulfil before it can embark on a formal investigation and will bring Northern Ireland law into line with that in Great Britain. The article requires the commission, when it proposes to inquire into whether a named individual has committed an unlawful


act, to inform that individual of the commission's intention to investigate and to offer the individual concerned the right to make oral or written representations and to be legally represented. We believe that it is right that the powers of the investigating body, and the rights of individuals who might be the subject of such investigation, should be the same throughout the United Kingdom.
Article 9 clarifies the maximum amount an industrial tribunal may award in respect of complaints presented to it by individuals under the Sex Discrimination Order. This limit has been set at £8,500 since 1 April 1987.
While article 10 is a minor amendment, I am sure that it is a welcome one to the Equal Opportunities Commission as it extends its discretion to assist individuals in the preparation, and the presentation, of a complaint to an industrial tribunal where there is some special reason for affording such assistance.
By contrast, article 11 of the draft order is again designed to bring our equality laws into line with the European Community equal treatment directive. The European Court judgment that gave rise to the changes in article 3 also required us to make void discriminatory provisions in collective agreements, internal rules of undertakings and rules governing the independent occupations and professions.
Another key objective of the draft order is the repeal of restrictions on hours of work. Article 12 removes from the Factories Act (Northern Ireland) 1965 outmoded and discriminatory restrictions on hours of work for women in such undertakings. It also removes the power to impose such restrictions under the Mines Act (Northern Ireland) 1969 and the Quarries (Northern Ireland) Order 1983. The repeals will put women in the manfacturing sector in Northern Ireland not only on a par with men in the same occupations, but with other women in jobs where there are no legislative restrictions on hours of work.

Mr. David Alton: Will the hon. Gentleman say how that will affect people who might be involved when working in the nuclear industry, especially those who may be affected by radiation-related diseases? Will he comment on the possible detrimental effects to a woman's health, especially when she is pregnant?

Mr. Viggers: The hon. Gentleman makes a fair point. It is unreasonably believed by some that women are less capable of taking on manual and other work than men. Informed opinion now recognises that that is not the case. However, for gynaecological or other reasons, women could, obviously, be unsuited for work. I will investigate the specific point made by the hon. Gentleman and, with the leave of the House, I will refer to it in my reply.
Finally, article 13 of the draft order closes a small loophole in the sex discrimination laws by preventing district councils from using public entertainment licensing powers in a sex discriminatory way. I know of no district council that discriminates in this way, but as the European Commission considers the United Kingdom legislation to be deficient in this respect we have taken the necessary steps to rectify it.
The reforms introduced by this draft order are a further step in what I would hope is a common goal of promoting

equal opportunities and flexibility in employment. The order also removes some unnecessary restrictions. I believe it is a major step towards true equality between the sexes and commend it to the House.
I have sought to deal briefly with the specific points raised in the order, but I will be happy—with the leave of the House—to deal with points raised during the debate.

Ms. Marjorie Mowlam: I thank the Minister for the detailed explanation of the articles in the draft order. I am sure that some of them will be warmly welcomed by people in Northern Ireland, but, clearly, some of them will not.
The Minister gave two explanations for the order being introduced. First, he said that it was to bring Northern Ireland legislation into line with that in the rest of the United Kingdom. He referred especially to articles 7, 8, 9 and 10. His second justification was that the order brings Northern Ireland legislation in line with European Community law. In particular, he mentioned the judgments of the European Court of Justice at Luxembourg, and he referred especially to articles 3 and 12.
It has to be said that the Minister was a little liberal with his definition of causality. Many people in Northern Ireland would argue that the British Government introduced parts of this legislation not because of an unswerving desire for greater equality for women but because the changes were forced on them by the European Court of Justice, which found that the British Government had failed to comply with the equal treatment directive in employment, vocational training, and working conditions. The Minister is aware that that directive was binding on the Government.
We welcome some of the proposals in the order which bring about positive changes for women. We welcome those which end the exclusion of sex discrimination legislation in undertakings of fewer than six people. We also welcome employers and partners having to provide equality in retirement age and equalisation of the age of unfair dismissal. We have many criticisms of the order, but in view of the late hour I shall concentrate on just four.
First, why has it taken so long for this legislation to be introduced in Northern Ireland? Article 3 bans discrimination against people employed in undertakings of six or fewer people. We welcome that article because if someone is discriminated against in a shop where there are, say, five employees, it ought to be dealt with. We cannot understand why it has taken so long for that legislation to be introduced in Northern Ireland. The European Court of Justice, in the case of the European Commission v. United Kingdom, said in 1983 that that exemption was unlawful.
The exemption was deleted for Britain in February 1987. As the Department of Economic Development has said, it is estimated that the change will affect more than 3,600 employees who work in small firms in Northern Ireland. It will not be sufficient for the Minister to say, as Lord Lyell said for the Government in the other place yesterday, that this is the first opportunity that the Government have had. To many people in Northern Ireland, that response suggests a lack of desire to implement the European Court's ruling.
Secondly, why are the Government complying with some obligations under European law but not others? The Government seem to be selective about which bits of European law they will implement. Articles 4 and 5 illustrate the anomalous position in which the Government have put themselves.
We welcome the Government's compliance with the provision that employers and partners have to provide equality in retirement age, particularly as women, on average, live seven and a half years longer than men. But how can the Government then ignore parts of the European directive which would stop the blatant discrimination that continues against women in relation to redundancy payments and pension entitlement? It will not be satisfactory for the Minister to argue that those items fall outside the scope of the equal treatment directive and that therefore he does not need to consider them. In the case of Cato v. Queen Charlotte's special health authority, it was found that to specify different age limits for redundancy was in contravention of European law.
Thirdly, the Government are threatening women's rights rather than helping them, as the draft order equalises downwards. Article 12 is an example of that. It removes protective legislation from women. Under the guise of equality, the Government are saying that women will be treated in the same way as their male counterparts. The Minister mentioned the Mines Act (Northern Ireland) 1969, the Quarries (Northern Ireland) Order 1983 and the Factories Act (Northern Ireland) 1965. We are talking here about important rights such as those that affect working hours, Sunday labour, rights to annual holidays and many health and safety protections.
We recognise that women in other areas of employment do not receive such protection, but instead of removing protective legislation the Government should review the situation to ensure that all workers are guaranteed minimum standards on working hours. We do not consider it unreasonable to expect that workers in this country should have rights to adequate breaks, adequate relief for shift work and adequate child care provision. We have only to look at countries such as Norway and Sweden to see that they have improved safety standards for workers. We are asking why we do not have the same here.
We are therefore arguing for equalisation up rather than down, as the Government propose. It is no good the Minister arguing, as he began to suggest, that that would in some way increase freedom of choice because the submission to which he referred—made after consultations with both the Irish Congress of Trade Unions and the Equal Opportunities Commission in Northern Ireland—argues that there is no evidence to suggest that it would increase freedom of choice for women. We rehearsed the arguments in the House when we debated Sunday trading and the reasons why those proposed changes would make the situation worse.
The fourth criticism that we should like the Minister to address is that, on balance, the order limits the powers of the EOC in Northern Ireland, while at the same time increasing its workload. We willingly accept that the EOC has been given the right to introduce a code of practice into specific firms. We accept that that is a useful tool and we welcome it, but it is a right which, as I am sure the Minister is aware, the EOC has had since the 1970s. At the same time, the order will limit the EOC's ability to be effective. It will limit how the EOC can introduce that code of

practice. It will force the EOC to give notice to a named individual that it is to carry out an investigation where unlawful discrimination is thought to be taking place.
In addition, the EOC must substantiate the belief that unlawful discrimination is taking place. As I am sure that the Minister and hon. Members are aware, discrimination is sometimes difficult to see. It is often hidden and indirect. It takes many forms and, therefore, to ask the EOC to substantiate a belief is very problematic. Perhaps, when the Minister answers our questions, he will define for us what belief means in the context of the order.
It would be useful if the Minister could clarify what the explanatory note means when it states that no significant effect on public expenditure will result from the order. The order increases the remit of the EOC in Northern Ireland and, therefore, one would assume that there would be a subsequent increase in the EOC's budget to handle that increased remit. When that question was put to Lord Lyell in the other place yesterday, the answer was unclear and we would appreciate it if the Minister would clarify that point.
I am sure that the Minister would like to join me in welcoming the good work done by the EOC and Mary Clark-Glass in the past year, particularly the recent success in giving girls aged 11 the right of transferability without having a percentage barrier to their chances to go on to specific schools. I am sure that the Minister will welcome the progress that the commission ensured in that legislation.
The order proposes only piecemeal amendments to the current legislation. It does not in any way fulfil the Government's obligations, under the equal treatment directive. We argue, therefore, that it will lead to further litigation in the European Court of Justice. A particularly worrying, underlying dimension that runs through the order is that the Government's proposals are primarily motivated by a desire to deregulate, rather than by a real commitment to remove sex discrimination. It is clear that the Government's response to their European obligations has yet again been to propose changes that would repeal sexually discriminatory legislation at the cost of the removal of essential protection in health and safety at work for women.
The order is too little and too late for women in Northern Ireland. There are many obstacles that will present serious problems to the creation of true equality between the sexes. The Minister claimed that it represents a major step forward, but we consider it to be a small step forward and two steps backwards. It avoids dealing with the main issues of discrimination. We shall continue to challenge the Government on the widespread discrimination which still exists and press them for a much more detailed examination of current sex discrimination legislation.

Mr. Eddie McGrady: I am glad to have the opportunity to contribute to the debate. Last Friday, the House discussed the White Paper on fair employment legislation in Northern Ireland and it is appropriate that we are now discussing disadvantage due to sex discrimination. It is significant that last week in the High Court at Belfast, Judge Hutton ruled that two education and library boards and the Department of Education were guilty of indirect discrimination in respect of 11-plus


examinations. That illustrates the attitudes that lie within the ethos of sex discrimination. There are probably many laws and regulations that contain discrimination, both direct and indirect, that have yet to be tested in the courts. The order seems to be a piecemeal response to a problem that is endemic. It reflects a lack of initiative to deal with the problem in its totality.
My party, along with many other organisations, including the Equal Opportunities Commission, made detailed submissions to the Department of Economic Development of Northern Ireland. My party's submission was at one with that of the EOC and those of many other bodies. It sought equality of status for all women on the work floor, in the office and in the professions. My party expressed its misgivings and made proposals for alterations. After the period for consultation came to an end the order was published, and it appeared that not one material change had been made to it. It seems that no cognisance was taken of the many submissions which were made during the consultative period. It would seem that it is a waste of time being involved in that process if it ends with no changes being made to the original proposals.
There have been changes in employment, one of which is the greater participation of women in work. The statistics showed that last March, in Northern Ireland, almost 250,000 women were in employment. It is significant that over 7,000 women are self-employed. In addition, there has been an influx of women into the professions and the higher echelons of the Civil Service, but those are the exceptions. Many women in employment are concentrated in the part-time arena in low-status occupations. Many are concentrated also in the easily exploited service sectors such as hairdressing, contract cleaning and catering. It is important that employers understand the vital role that they have to play in the promotion of equal opportunity for women. Legislation such as that which is before us should address itself to the totality of the problem. As the hon. Member for Redcar (Ms. Mowlam) said, the order represents a piecemeal approach.
There is no denying that the order contains advances, which we welcome, especially in relation to private households, small undertakings and partnerships, retirement ages, collective agreements and rules of undertakings. These have been dealt with in some detail by the hon. Member for Redcar and it will not be necessary, therefore, for me to do so.
Having welcomed those particular aspects of the order, I may add that it has a number of serious shortfalls, which must be addressed. The draft order proposes repealing certain protective legislation. I agree with the hon. Member for Redcar that that would be a retrograde step. The order would appear to discard certain rights that women need and that ought to remain on the statute book.
The Equal Opportunities Commission would be empowered to issue new codes of practice containing practical guidance on eliminating discrimination in employment and on promoting equal opportunities as between men and women. We hope that such codes would be persuasive in respect of industrial tribunals. However, the draft order embodies proposals that would narrow the terms of reference applying to formal investigations by the EOC. Such restrictions have already been identified by the

English and Welsh commissions as being limiting, and we now appear to be repeating that error in the draft order that is before the House tonight.
The investigations upon which the EOC could embark will be restricted to individuals only, and only where there is a preconceived idea that discrimination has occurred. The order would also allow for something that is a matter of concern to many having experience of this subject. I refer to protracted, pre-investigation representations, which could bog down the whole investigative process, introduce unnecessary delay and cost, and draw further on the commission's resources.
The Government have failed to introduce promised amendments relating to equal redundancy benefit entitlements for women working in the private sector in Northern Ireland, who will not enjoy the same benefits as women employed in the statutory sector. That is obviously unfair, and does not make for equal opportunity.
Under an EEC directive that will become operative next year, there must be equal retirement and pension plan ages for men and women in respect of occupational pension schemes. It would appear that the Government have failed to legislate for that equality in social security reforms affecting retirement ages, which is an aspect that the order should have addressed.
The Government have demonstrated a lack of commitment and willingness to provide equal opportunities by, for example, imposing restrictions on the EOC. The order will place a greater burden on the commission to exercise the responsibilities with which it is charged. It is a great pity that the opportunity has not been seized to deal with the problem in its totality. I am certain that further directives and legislation affecting both Northern Ireland and the EC will be tested in the courts, and that it will be only a short time before we find ourselves debating another amended order on sex discrimination. It is regrettable that the opportunity has not been taken to deal in this order with the totality of the problem as we know it to be, and to deal with the differences that exist today.
The hon. Member for Redcar spoke of the Government taking one step forward and two steps back. I may add that the representations that were sought and made were, by and large, ignored in the final draft order. That was a retrogade step, and regrettable.

Mr. Eric Forth: This is one of those profoundly depressing occasions when one finds one's own Government submitting, it would seem, to the combined forces of the Europeans on the one hand and that dreadful equal opportunities industry on the other. I am reassured only by the fact that some Opposition Members are dissatisfied with what my hon. Friend the Under-Secretary of State has brought before us tonight. That gives me some slight cause for hope.
My hon. Friend has not explained why the existing body of so-called equal opportunity law and that great bureaucracy of the equal opportunities industry that exists here on the mainland—our friends in Northern Ireland have up to now been spared the worst excesses—should be applied to Northern Ireland rather than that the mainland should be brought into line with Northern Ireland.
All of us know perfectly well that the fair sex need no body of legislation or interference, even by my hon. Friend, to give them equality. They are already superior in


almost every respect to the male. What the males among us have to ensure is that we try to retain some sort of equality for as long as possible before ladies take over in almost every respect.
It always surprises me that even such an eminent political figure as the hon. Member for Redcar (Ms. Mowlam) should expect legislation to protect her sex against the depradations of mine. It seems perfectly obvious that, with a lady as Head of State and a lady who is Head of Government, women are increasingly running everything in sight. The mere suggestion that we need legislation, created mainly by men, to protect them is patently ludicrous. For my hon. Friend to suggest that that absurdity should be extended to the good people of Northern Ireland is, to say the least, regrettable.
But what my hon. Friend has not explained to any of us is something that he said in his opening comments when I was encouraged momentarily. However, the moment passed. He said that his measures would reduce unnecessary bureaucracy. My heart soared when he said that. I thought that here was one small chink of light in this depressing and black moment in politics because, among this great morass of nonsense before us this evening, which I guess the House will approve, much to my regret, my hon. Friend offered us the hope that there might be a reduction in bureaucracy.
Regrettably, my hon. Friend left that point and moved on to wade through the great jungle of provisions that will weigh upon business and the community in Northern Ireland, liberating positively no one. Just to reassure me and bring me into the Lobby with him tonight—I am sure that we shall divide on such an important matter as this—will my hon. Friend tell me in what respect bureaucracy is reduced?
My hon. Friend said almost in the same breath that we were to extend the provisions to small undertakings of fewer than six employees. My simple mind, even at this late hour, can just about grasp the idea that if my hon. Friend is to extend this nonsense to small undertakings and impose these burdens on smaller businesses, bureaucracy will almost certainly have to be greater. I can envisage even more interfering busybodies going around muttering the shibboleths that are the basis of all this legislation——

Dr. Lewis Moonie: One does not mutter shibboleths.

Mr. Forth: I do not know what the hon. Gentleman does with shibboleths, but I should have thought that most hon. Members would mutter shibboleths. They could articulate them, they could even chant them, but I suspect that the hon. Gentleman, who is usually a sensible man, would probably mutter shibboleths, as he was doing earlier on the subject of the National Health Service. But let me not be distracted because I sense that my hon. Friends are becoming slightly impatient.
I simply want to press my hon. Friend on a relatively important point. Can he reassure me that the bureaucracy of the equal opportunities industry in Northern Ireland will not be increased by the measures that he is putting before the House tonight? If he tells me that yet more civil servants will not be going around interfering in yet more ways in people trying to go about their ordinary business to earn an honest penny, I would be reassured. If he cannot tell me that, I shall, as I already suspect, be confirmed in my suspicion that yet another burden is to be placed on

law-abiding, ordinary people. I am very disturbed that my hon. Friend, by talking about sex equality, will add to the burdens of industry and business, prejudice the possibilities of employment and increase the possibilities of interference by commissions, courts and other unnecessary bodies.
I hope that, even at this late stage, my hon. Friend will think again and suggest to his ministerial colleagues in other Departments that they should seek to reduce the role of the equal opportunities industry on the mainland and bring it into line with what I gather is the eminently sensible basis of the equal opportunities so-called industry in Northern Ireland.

Mr. David Alton: The speech of the hon. Member for Mid-Worcestershire (Mr. Forth) has made me more enthusiastic about the order than I thought I might be. Unexpectedly, I share one or two of his reservations. I agree with him when he said that simply multiplying bureaucracy and orders clearly is not the answer to ensuring fair employment, equal opportunities, or increased employment. That is the overriding need in Northern Ireland where just under 18 per cent. of people are out of work and some 31,000 women and 86,000 men are currently on the dole.
In the context of our debate last Friday, when we considered the creation of new rules and regulations to stop discrimination in employment on grounds of religion, there is a danger that by multiplying commissions. orders and regulations we shall prevent people being able to employ anybody. The orders could become so much in conflict with one another that it will he impossible for anyone to employ anyone without fear of prosecution, so we have to be cautious in the way in which we approach the legislation.
To be debating at this time, in a maximum period of 90 minutes, should we wish to use it, an order that becomes the law of the land in Northern Ireland is an inappropriate way of dealing with legislation. We regularly use this beat-the-clock method of legislating on unamendable orders and, although there is some worth in the measure before the House tonight, hon. Members will simply have to vote for or against it. These orders do not allow for any nuances in politics and that is one of the worst things about dealing with Northern Ireland issues. It has attracted so much attention among hon. Members representing Northern Ireland that the hon. Member for South Down (Mr. McGrady) is the only hon. Member from Northern Ireland in the House this evening. That shows the nonsense of the way in which we deal with such matters.
Instead of the "ad hoc-ery" and instead of bringing forward unamendable orders, how much better it would be if we could consider the issues on a wider basis for the United Kingdom and in the European context. Changing patterns of work will require us to think long and hard about the way in which we provide employment opportunities in future. Rather than more and more legislation, provisions for sharing work will be more important in future. We must give each person the chance to a job, the chance to make a contribution to the community, and we must insist that they receive proper remuneration for that work The order clearly does not allow for any of that.
My chief concern is that one standard will exist for dealing effectively with religious discrimination, which we debated last Friday, but other forms of discrimination will be dealt with in altogether different ways. For instance, we are told absolutely nothing about discrimination on the grounds of disability. It is absurd to introduce an order into Northern Ireland on the pretext of harmonising United Kingdom legislation, when the sole justification for the White Paper was that special Northern Ireland circumstances required special measures. It is ludicrous to introduce laws based on principles which are out of step with our commitment to European harmonisation.
I wonder increasingly about the merit of such orders. It is absurd to expect a company such as Harland and Wolff or a major construction company to employ vast numbers of women. But in the expanding service sector, where there are increasing opportunities for women to be appointed, there needs to be some mechanism to ensure that that happens.

Mrs. Maria Fyfe: Is the hon. Gentleman aware that during and after the last war hundreds of women worked in the shipyards in jobs that previously had been thought to be unsuitable for women?

Mr. Alton: We know that happened. Indeed, as a result of jobs that women performed during the first world war, the suffragette movement, which had been unsuccessful prior to that war, achieved success in 1919. In the absence of men at the front line women did their jobs. That resulted in the demand for women to gain the suffrage becoming irresistible. But I do not agree with the hon. Lady's suggestion that we should be demanding that women should be encouraged to do certain jobs. I am simply asking that in those areas where we should expect to see women being appointed and promoted—for instance, in the massively expanding service sector, in local government and in public services—such developments should be occurring.
Under article 8(3A) of the order, the commission's powers to deal with promotion of job opportunities for women is being limited because it is being given a reactive rather than a proactive role. The commission will not be allowed to initiate an inquiry where it is clear that a major employer is not showing any regard to equal opportunities. It is the blatant and deliberate abuse that concerns me.
I subscribe, as I suspect most hon. Members do, to the merit principle, but I can see the dilemma for an employer faced with several applicants for a job. All may be of comparable merit. The employer should not be pilloried for hiring the man with a dependent wife and family at home rather than another applicant. My concern is for the industry or public service where discrimination is institutionalised and unchallenged. In this order the Government had the opportunity to give power to do something about that.
I am concerned in that trade unions can be part of this institutionalised discrimination. Often it is built into collective agreements. By removing the power of industrial courts to deal with collective agreements, as the order does, it will make it easier for trade unions to negotiate for

their members regardless of wider considerations. The duties of trade unions and the Government are clearly different, and the order should have reflected that.
My last concern is the one I raised during the Minister's opening remarks. It is that on the pretext of equalisation some valuable protection is likely to be removed, and that will leave some female employees open to exploitation.
The order is not welcomed by the Equal Opportunities Commission and others working in the field. It does not take into account changing attitudes about work. It should be part of a wider reassessment of how we structure our society and cater for each person's aspirations, including those women and men who prefer to spend more of their time bringing up their children and coping with their families. It also illustrates yet again how inappropriate is this 90 minute, beat-the-clock, unamendable procedure. For those reasons I shall advise my hon. Friends to oppose the order if there is a vote tonight.

Mr. Viggers: I suggest to the hon. Member for Liverpool, Mossley Hill (Mr. Alton) that this debate has shown the value of the 90-minute procedure. Nobody is suggesting that it is a perfect situation in which we find ourselves. All hon. Members must feel that the procedure by which Northern Ireland instruments come before the House late at night and have 90 minutes for debate is far from satisfactory.
In so far as it is, I urge hon. Members, especially those with constituency responsibilities in Northern Ireland, to co-operate in discussions as actively as possible so as to produce a better system. But if we must have 90-minute debates on orders, I should have thought that this one would be a model because some extremely effective and important points have been made, and I shall deal with them.
The hon. Member for Mossley Hill, in an intervention in my earlier remarks, spoke of women working in the nuclear industry. Broadly, they are unaffected by the proposed draft order.
There is, of course, already a general duty imposed on employers by the Health and Safety at Work (Northern Ireland) Order 1978 to ensure, as far as is reasonably practicable, the health, safety and welfare of employees, and if an individual woman worker is pregnant no doubt that should be taken into account. I have no detailed brief on that and if the hon. Gentleman wishes to pursue the point I shall be happy to respond to any representations that he makes.
Turning to the points made by the hon. Member for Redcar (Ms. Mowlam) in her speech from the Opposition Front Bench, her first substantial point was that the Government have been slow in bringing forward the draft order. I have to repeat the point made by my noble Friend Lord Lyell in the other place, because in the absence of a legislative vehicle, such as the Race Relations Act 1976, which applies in Great Britain, there has been no opportunity in Northern Ireland legislation to incorporate the Sex Discrimination Act 1975, and it was not thought by the Government to be possible to bring before the House a draft order that dealt only with these individual points. So in the absence of any legislative vehicle— a hook, as it were, on which to hang the legislation—there has not been a convenient opportunity.
Secondly, the hon. Lady made the point that the proposals do not fulfil the Government's obligations under the equal treatment directive. During the passage of the Sex Discrimination Bill the European Commission was provided with copies of all published prints of the Bill and of the final Act of 1986 and at no stage did it suggest that our proposals did not meet Community law or the European Court judgments, which gave rise to some provisions. As the draft Northern Ireland order under consideration replicates the provisions of the 1986 Act, we are confident that it meets Northern Ireland's obligations under the equal treatment directive.
The hon. Lady asked about redundancy payments. I confirmed to the House on 8 December 1987 that changes in the age limits for statutory redundancy payments proposed for Great Britain will also apply to Northern Ireland. This will be done as legislative time permits.
The hon. Lady also asked about state pension age and suggested that this also should be balanced. This is a matter for my right hon. Friend the Secretary of State for Social Services, but I can say that work on reappraising the cost and economic implications of equalising pension ages has been under way since 1980, along with full consideration of a number of options. We hope to reach a conclusion on the matter during this year.
The hon. Lady also referred to article 8 of the draft order and criticised the fact that in future it will be necessary for the EOC to justify its investigations. This is a parity measure. It is right that employers in Northern Ireland should enjoy the same rights in respect of formal investigations as their counterparts in Great Britain. The commission has undertaken only two investigations under its existing powers in the last 12 years and I cannot imagine that the change made by article 8 will be a major disadvantage, as has been claimed.

Ms. Mowlam: The Minister is absolutely correct to say that there have been only two cases in the past 12 years, but that may relate more to the fact that there is only one member of staff dealing with the problem than to the nature of the demand.

Mr. Viggers: That allows me to lead in beautifully to a point on resources, which the hon. Lady also made. It is a recurring theme in the happy dialogue between the EOC in Northern Ireland and the Department of Economic Development, for which I am responsible, that further funding would be welcomed. But the amount of funding of the EOC in Northern Ireland is 321 per cent. higher than the per capita amount of EOC funding in Great Britain. If one says that it is always necessary to have a larger amount of funding because a smaller organisation necessarily has more overhead costs, I must say that the Northern Ireland block generally works on a population basis, so such an argument could be applied to every organisation in Northern Ireland. I maintain that a funding of 321 per cent. higher than the funding in Great Britain must be regarded as reasonably satisfactory. I am sure that my hon. Friend the Member for Mid-Worcestershire (Mr. Forth) regards it as fully satisfactory.
The hon. Member for South Down (Mr. McGrady) asked about the current judicial review sought by the Equal Opportunities Commission against the Department of Education. This case has been adjourned in the High Court until tomorrow for the completion of the judgment.
The hon. Gentleman and the House will appreciate that: it would not be prudent for me to comment further until the final outcome is known.
The hon. Gentleman also made the point that the Government ignored—to use his word—representations made on this draft order. The Government distributed a copy of the draft order and invited representations from 85 organisations, of whom 29 responded. Nearly all responded by a simple acknowledgment, but nine made representations. These were considered carefully. It is true that the Government continued with their proposal to introduce the order as originally drafted. However, representations are not ignored; they are carefully considered. They were carefully considered and taken fully into account—and changes were made—in the White Paper that we debated last Friday. There are a number of respects in which the arrangements for Northern Ireland differ from those for Great Britain. To take an example from my Department, the provisions for both adult and youth training are quite different in Northern Ireland and take account of special local factors and the representations that have been made to us.
My hon. Friend the Member for Mid-Worcestershire lambasted me about the provisons. I respond to him. in the context of the forthcoming Kensington by-election, by describing myself as drier than Dudley Fishburn. I can assure him that the repeals in the proposed measure will lift a bureaucratic millstone from employers in the manufacturing sector. The current restrictions are complex and entail a mass of paperwork, detailing the period of employment, hours, overtime and meal breaks of women employees. The order will also allow employers and their work forces additional flexibility, with the prospect of organising working hours to optimum effect. There are also some simplifying measures in the draft order.
I reiterate that the changes introduced by the order will extend to women in employment in Northern Ireland the benefits that are already enjoyed by women in the rest of the United Kingdom. While the European Community has been a catalyst in this process of development, the changes reflect the Government's ongoing commitment to the removal of unfair sex discrimination and the promotion of equal opportunities between men and women.
I commend the order to the House.

Question put:—

The House divided: Ayes 82, Noes 31.

Division No. 398]
[12.52 pm


AYES


Amess, David
Carlisle, Kenneth (Lincoln)


Amos, Alan
Carrington, Matthew


Arbuthnot, James
Carttiss, Michael


Arnold, Jacques (Gravesham)
Cash, William


Ashby, David
Chope, Christopher


Baker, Nicholas (Dorset N)
Conway, Derek


Baldry, Tony
Coombs, Anthony (Wyre F'rest)


Batiste, Spencer
Couchman, James


Bennett, Nicholas (Pembroke)
Cran, James


Bevan, David Gilroy
Davies, Q. (Stamf'd amp; Spald'g)


Bonsor, Sir Nicholas
Davis, David (Boothferry)


Boscawen, Hon Robert
Day, Stephen


Bowis, John
Dunn, Bob


Brandon-Bravo, Martin
Durant, Tony


Brazier, Julian
Dykes, Hugh


Brooke, Rt Hon Peter
Emery, Sir Peter


Burns, Simon
Fallon, Michael


Burt, Alistair
Forsyth, Michael (Stirling)


Butcher, John
French, Douglas






Garel-Jones, Tristan
Pawsey, James


Gill, Christopher
Porter, David (Waveney)


Greenway, John (Ryedale)
Raffan, Keith


Griffiths, Peter (Portsmouth N)
Ryder, Richard


Hamilton, Neil (Tatton)
Shaw, David (Dover)


Hargreaves, Ken (Hyndburn)
Smith, Tim (Beaconsfield)


Harris, David
Spicer, Michael (S Worcs)


Hawkins, Christopher
Stern, Michael


Hayward, Robert
Stewart, Allan (Eastwood)


Hind, Kenneth
Stradling Thomas, Sir John


Holt, Richard
Taylor, Ian (Esher)


Howarth, G. (Cannock amp; B'wd)
Thompson, Patrick (Norwich N)


Hunt, David (Wirral W)
Twinn, Dr Ian


Hunter, Andrew
Viggers, Peter


Irvine, Michael
Waddington, Rt Hon David


Jack, Michael
Waller, Gary


Jones, Gwilym (Cardiff N)
Watts, John


Lennox-Boyd, Hon Mark
Widdecombe, Ann


Lightbown, David
Winterton, Nicholas


Lloyd, Peter (Fareham)
Wood, Timothy


Maude, Hon Francis



Neubert, Michael
Tellers for the Ayes:


Nicholls, Patrick
Mr. Stephen Dorrell and


Nicholson, David (Taunton)
Mr. David Maclean.




NOES


Alton, David
Hughes, John (Coventry NE)


Barnes, Harry (Derbyshire NE)
Ingram, Adam


Battle, John
Lloyd, Tony (Stretford)


Beckett, Margaret
McAvoy, Thomas


Brown, Nicholas (Newcastle E)
McKay, Allen (Barnsley West)


Campbell, Menzies (Fife NE)
Marshall, Jim (Leicester S)


Cohen, Harry
Meale, Alan


Cryer, Bob
Michael, Alun


Dewar, Donald
Morley, Elliott


Dixon, Don
Mowlam, Marjorie


Dunnachie, Jimmy
Nellist, Dave


Flannery, Martin
Short, Clare


Foster, Derek
Skinner, Dennis


Fyfe, Maria



Galbraith, Sam
Tellers for the Noes:


George, Bruce
Mr. Frank Haynes and


Gordon, Mildred
Mr. Ray Powell.


Graham, Thomas

Question accordingly agreed to.

Resolved,
That the draft Sex Discrimination (Northern Ireland) Order 1988, which was laid before this House on 17th May,be approved

Mr.Bob Cryer: On a point of order,Mr. Deputy Speaker. You will have learnt with some

concern of the result of that vote, for which the Government have not been able to keep their numbers. The Government have a duty to see that their legislation is put through the House, and they require 100 Members for a closure vote. Has the Prime Minister notified you that she will come to the House and make a statement about the inadequacy of the organisation? I wonder whether she can carry on the Government in the face of this lamentable organisation by the Tory Whips.

Mr. Deputy Speaker (Sir Paul Dean): I realise that the hon. Gentleman has been having his little bit of fun. It was, however, hypothetical, because the closure was not moved, and the Division was perfectly in order.

PETITION

National Health Service

Dr. Lewis Moonie: It is appropriate that tonight, on the 40th anniversary of the founding of the National Health Service, I should be asked to present this petition on behalf of the Royal College of Nursing. It has been signed by 500,000 people from all parts of the United Kingdom, including more than 26,000 from my county of Fife. The sheer scale of the response to the petition is surely a true sign of the depth of feeling engendered by this issue.
The main points of the petition are as follows. We are asked to
reaffirm that the National Health Service shall remain funded from taxation and free at the point of delivery; legislate to remedy the cumulative underfunding of the National Health Service identified by the House of Commons Social Services Select Committee; implement and fully fund the recommendations of the Review Bodies for health service staff pay; ensure through legislation that spending on the National Health Service grows to meet the health challenges posed by longer life expectancy, new medical advances and emerging medical problems; affirm that health shall receive a fair share of the nation's wealth.
I can add nothing to that.
To lie upon the Table.

Barlow Clowes

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Lennox-Boyd.]

Sir Peter Emery: The problem concerning the Barlow Clowes affair cannot and should not escape parliamentary consideration. In an entirely honest and well-run financial investment market, the affair should never have happened. Because Barlow Clowes recieved the stamp of approval from the Department of Trade and Industry, it is not surprising that many investors in these companies feel that they should have been alerted long before the terrifying collapse came about. Like many other hon. Members on both sides of the House, I have received dozens of letters from constituents expressing concern at their unbelievable financial loss through their investments.
There are many complications, but let us try to sort out the matter. Two companies are involved: Barlow Clowes Gilt Managers, with 7,400 clients investing £52 million; and Barlow Clowes International, the Gibraltar organisation, with 11,500 clients who had invested over £138 million. As I understand the position, the liquidators have realised £52·3 million from the gilts management company but only about £16 million from the Gibraltar company, where it appears that there is an unsecured loan book of £85 million.
It seems that £62 million had been lent to companies associated with Peter Clowes and £13 million to companies associated with Guy von Craamer, while £2 million went to James Ferguson Holdings—the parent company for the Barlow Clowes operation—£2 million to a Geneva accountant, who is an ex-chairman of James Ferguson, a Mr. David Mitchell, and £1 million to Dr. Peter Naylor, another director of James Ferguson. It would appear that some £40 million is missing, and that as much as 80 per cent. of the loans authorised by Clowes in the loan book is unlikely to be recovered.
The tragedy of all this is the number of small investors who were taken in by the belief that their investment was safe in Government gilt-edged securities—investors who were advised by a number of professional financial advisers, whose marketing technique is much open to question and who appealed especially to retired persons. The investments catered for providing half-yearly or even monthly distributions, and are known in some circumstances to have been recommended on writing paper from the Retired Persons Investment and Pensions Advisory Service, with a message headed "Guaranteed Income-Investment Services". They enclosed
a schedule of actual return you will receive from your investment in the Guaranteed Income-Investment Services equivalent to 15·42 per cent. gross.
The letter closes with the phrase:
I am very pleased that you have taken advantage of this excellent guaranteed investment which provides a high income guaranteed not to fall.
If that is not pretty near fraud, I do not know what is.
I should like to ask the Minister a number of questions. Before I do so, however, I think it right to stress that those who wish to condemn the Department of Trade and Industry must understand one thing. In the carrying out of any investigation, if it becomes apparent or leaks out to investors that a company is under suspicion, that can bring about a major loss of confidence in the company. The possibility then arises that the very investigation, at its

inception, could he the cause of a considerable loss of funds for investors. The DTI must act to help rather than hinder honest companies and proper investment. In carrying out its responsibilities, it must perform a very difficult balancing act, and circumspection is essential.
Will the Minister let the House know how many official complaints or intimations of concern were received by his Department about Barlow Clowes from 1985 to 1988? If the investigators were appointed in October and November of last year, under section 106 of the Financial Services Act, why was Barlow Clowes not warned not to accept any further investments until an interim report from the investigators had been received? If this had happened, a considerable number of people who later invested would have been saved.
Does the appointment of Sir Godfray Le Quesne to investigate the facts concerning the Department's handling of the matter preclude any investigation being carried out by the Parliamentary Commissioner, the ombudsman, as has been suggested? I should like to know the answer, because, if that is the case, for how long will this hold sway? Limitation on the action of Members of Parliament referring matters to the Parliamentary Commissioner is unacceptable and something that the House will want to take up quickly.
Although it has been made clear that the report by Sir Godfray will be published, may we be certain that we can have that report, given to the Minister, preferably by September, but certainly by October? Any further delay would be unacceptable. Is it correct that the police in Manchester were carrying out certain investigations into the Clowes companies as long as two years ago? Did the Department know this?
Has my hon. Friend considered the position of certain of the financial advisers associated with placing Clowes investments, two of whom, I believe, have now had their licences withdrawn? Have these companies indemnity insurance? Any professional financial adviser who persuades an investor to put all his money in one fund rather than having a spread of investments is hardly professional. Then to give advice to put all the money into a fund that is allegedly giving a return, supposedly in gilt-edged securities, which is considerably above the return that any other similar investment could bring must be considered to be providing dubious advice, and perhaps even fraudulent advice. Should not the Department be looking into this side of the affair much more fully?
Should there not be a more full inquiry that will consider the position and the relationship of Spicer and Pegler, the auditors, Touche Ross and Co., which advised and recommended Clowes backing into James Ferguson, and Singer and Friedlander, merchant bankers to Clowes' deals? Should not these highly professional firms have smelt a rat? If not, why not? Surely the public has a right to know, and it may not be just the Department that has to carry blame.
Factually, the investors in Barlow Clowes International, the Gibraltar company, are likely to suffer a severe loss, if not a total one. Any distribution from this investment is likely to take years rather than months because of the complexity of the situation, and the difficulty in realising or obtaining refunds of loans. However, there are two specific problems about the gilts management company, although there is also more hope. The first problem is ascertaining whether some of the funds realised by the liquidators was money put in from


Gibraltar, or from other sources, to prop up Barlow Clowes Gilts Management because the Securities and Investments Board was breathing down its neck.
Secondly, a new factor has emerged. The Inland Revenue has put the special office of the inspectors into the company. Therefore, will the Minister use all his power to urge the Treasury to ensure that the tax implications are sorted out in days or weeks, rather than months or years? That is often what happens in such cases as this.
If that cannot be achieved because the Department is the official receiver and Cork Gully, which is doing an excellent job, is only the manager, will the Department consider two possible steps to help the 7,500 investors in the short term? It should either allow the fund managers to make a distribution, perhaps every three months, of the income arising from the £53 million in its hands and now invested so that the investors can obtain some income, or, as the official receiver, direct that a 10 or 15 per cent. distribution be made, for which purpose it should approach the court. In either case, obviously, distribution should be made only to those investors who can substantiate their position absolutely to the satisfaction of Cork Gully, the fund managers.
If Sir Godfray reports in a manner unfavourable to the DTI—and I wish at this stage to make no judgment at all—may we have the assurance that the Government will take rapid steps to assess and to provide compensation? Whatever the outcome, this is an unhappy situation that can please no one. The Government must take, and would want to take, every possible step to bring it to a rapid conclusion.
What stands out above all else is that anyone placing his savings in an investment should always ensure that his capital is spread in a number of accounts or companies and never placed in a single investment. Secondly, caveat emptor, the investor must beware if the financial dividends suggested or advertised are greatly above the normal market returns. That can be achieved only if the investor is taking considerable extra risks of loss, and risks which in this sad case most of the investors believed they were being guaranteed against.
The Government cannot brush this matter under the carpet. There must be no cover up, and I do not believe that the Government would want that. Where there is fraud or malfeasance, prosecutions must quickly be brought. If there is culpability at the DTI, compensation must be assured.

Mr. Nicholas Winterton: I am most grateful to my hon. Friend the Member for Honiton (Sir P. Emery) for permitting me to speak briefly. In doing so I declare a constituency interest. Not only have I hundreds of constituents who have been investors in the Barlow Clowes companies, but Mr. Peter Clowes is a constituent and his gilts management operation is based in Poynton in my constituency.
As the Parliamentary Under-Secretary of State for Corporate Affairs will know, I have in my files copies of correspondence dating back to 1984 that give not just a number of warnings about Barlow Clowes but show that the whole system of self-regulation of the financial services industry subsequently established by the Financial

Services Act is inadequate, does not work, and should never have been expected to work. The spectacular collapse of Barlow Clowes was not just possible under the Act, but was arguably a direct result of pressures arising out of the Act and changes in taxation policy. Warnings were given to the DTI, but were not heeded.
Long before the Financial Services Act was introduced, I, on behalf of a constituent, Mr. Peter Hayes, an investment consultant, alerted the Government to the inevitable results of the provisions of the Act. The Prime Minister was warned in a letter of 22 March 1984 that
the Act which may shortly be placed on the Statute Book will merely drive those with poor ethics in the industry to operate offshore—in Gibraltar.
Those were the warnings given to the Government about what was happening, but, sadly, those warnings were ignored.
Like my hon. Friend, I make a plea that the Government publish the internal inquiry report as soon as possible, but much sooner than he requested. I believe that it would be wrong to do it when the House is in recess and can do nothing about it. There is pressure, and a duty, upon the Government to have it published before the end of the month and before the summer recess. Many of those who invested were elderly and were relying on their investment to maintain an acceptable standard of living in their retirement.
There are literally thousands of investors in the south Manchester area. If there is any evidence in the report of neglect, maladministration or of something wrong in the Department itself, will the Government make compensation available at the earliest possible date?

Mr. Stephen Day: rose——

Mr. Deputy Speaker (Sir Paul Dean): Does the hon. Gentleman have the leave of the hon. Member for Honiton (Sir P. Emery) and the Minister to speak?

Mr. Day: Yes, Mr. Deputy Speaker.
I congratulate my hon. Friend the Minister and my right hon. Friend the Secretary of State on setting up the independent investigation, which is very helpful. I would also like the report to be placed before the House as soon as possible. We are talking not about people who invested for a quick overnight kill to buy a Porsche, but about people who are in dire financial circumstances as a result of the collapse.
The money that was invested came from such things as early retirement payments, redundancy money, matured insurance policies and savings. I know of 400 people in such circumstances. They looked for security in later life. It has to be said that one of the key elements in assuring them of that security was the DTI licence. Even though the licence applied only to the United Kingdom operation, its existence reassured Gibraltar investors. Both were sold as gilt-edged securities. I understand that there were doubts about the company previously. If the licence had been withdrawn from the United Kingdom operation, that would have saved many people from investing in the Gibraltar one.
I urge my hon. Friend the Minister to accept in principle, without making any commitment before he knows what the results of the inquiry might be, that if the report shows that the DTI's role contributed to the financial distress of investors, compensation will be


considered. These people are in dire straits and need some security for the future. Neither I nor the investors to whom I have spoken expect the DTI to carry the can for them. They accept some responsibility for their investments, but if the report shows that the Department was a contributory factor, it should make some announcement about compensation.

The Parliamentary Under-Secretary of State for Corporate Affairs (Mr. Francis Maude): My hon. Friend the Member for Honiton (Sir P. Emery) opened the debate by saying that this is a matter which it is proper for Parliament to consider. We do not shrink from that, and I am grateful for the opportunity to set out, in perhaps a little more detail than I was able to go into when I made a statement a few weeks ago, what the position is.
Nobody is more aware than me of the distress and anxiety that has been caused to thousands of people. Many right hon. and hon. Members have received letters from many constituents who are in this distressing situation. Many hon. Members have sent those letters to me, so I am acutely aware of the distress that has been caused and of the anxiety of many that the matter should be brought to a conclusion as soon as possible.
It is particularly distressing that, because of the way in which the Barlow Clowes schemes were marketed, a substantial proportion of investors are retired and can ill afford to lose their savings, as my hon. Friends have said. The House will understand that other creditors may be involved and that it is important, in fairness to everyone concerned, that the normal proceedings established by insolvency law should be followed.
Nobody who is involved in this process can be in any doubt about the impact that the events of the past few weeks have had on the lives of those people who are affected, and I am determined that all should be done as quickly as possible to establish what the prospects are of investors recovering any of their investments, and how quickly they might be realised.
In explaining this case, it is vital that we bear in mind that we are discussing principally two separate companies. The first is the United Kingdom firm, Barlow Clowes Gilt Managers Ltd. which, as I explained on 13 June, held a licence under the Prevention of Fraud (Investments) Act 1958 until 29 April this year. It subsequently operated under interim authorisation under the Financial Services Act until the Securities and Investments Board exercised its powers of intervention. Those powers of intervention were given to it by the Financial Services Act 1986. Those powers did not exist under the previous Act. It is important that I should make that clear to my hon. Friend the Member for Macclesfield (Mr. Winterton) because there has been some misunderstanding about that.
That company was also the subject of the section 106 investigation, to which I referred in my statement. As the House knows, the facts of my Department's handling of that case are currently under investigation by Sir Godfray Le Quesne and I know that the House will not, therefore, expect me to comment on those aspects of the case until Sir Godfray's report has been received. Several of the matters on which my hon. Friend the Member for Honiton asked me to comment fall fair and square within Sir Godfray's remit and it would be wrong for me, at this stage, to try to provide answers that might be incomplete.
It would surely be better for Sir Godfray's inquiry to take its course and for the full facts to be set before the public as soon as possible. He knows that it is our concern that that should be done as quickly as possible and he shares that concern. He has been at work for the past two and a half weeks and has said that he hopes to report to us before the House reassembles in the autumn. There can be no benefit to anyone in the investigation being too hurried. It must be done properly and I hope that he will take it as an earnest of our intentions that we believe that nothing should be swept under the carpet, that there should be nothing remotely resembling a cover-up, that all the matters should be fully investigated and that we should not seek to publish the report before Sir Godfray has had the fullest opportunity to investigate. None the less, he is aware of the urgency and has said that he hopes that it will be possible for him to report before the House reassembles.

Mr. Nicholas Winterton: I accept my hon. Friend's explanation, but will he say precisely what the position is over the licence granted to Barlow Clowes? As I understand it, the company was trading for a considerable period without a licence and was not granted a licence until September or October 1985, some two years after it had started trading and should have had a licence to do so,

Mr. Maude: I covered that matter in my statement of 13 June. The facts are broadly as my hon. Friend sets out, but they will be covered by the investigation.
My hon. Friend the Member for Honiton mentioned the possibility of investigations by the ombudsman. It is, of course, open to any hon. Member to bring a complaint from a constituent to the attention of the ombudsman, but it is for him, in every case, to decide whether he investigates. Section 5 of the Parliamentary Commissioner Act 1967 governing his powers outlines the circumstances in which he may not investigate, but it is, in every case, for him to make up his mind within the terms of the Act. There are no powers for the Department to prevent an investigation taking place, nor would we seek to do so.
Investors who have placed money with the United Kingdom company will naturally be keen to know where matters now stand. The court has appointed an official receiver as provisional liquidator, to prevent further prejudice to the interests of investors, and has also appointed joint special managers. The special managers are receiving information from investors, who should register their interests with them as soon as possible. The court will be hearing the petition for winding-up tomorrow, 6 July. Obviously, I cannot speculate on the outcome of that hearing. If the court were to make a winding-up order, the official receiver would need to call a meeting of creditors, and the creditors and shareholders would have the opportunity of appointing a liquidator to replace the official receiver.
The House will understand that these procedures inevitably take some time. I am much aware of the anxiety of investors, and I know that in the event of liquidation they will want the earliest possible indication of the prospects of recovering some or all of their money. I am aware also that there is concern about tax implications. Any tax implications that may emerge should be resolved at the earliest possible moment.
It seems likely—this may have been read by some—that investors with Barlow Clowes Gilt Managers Ltd. have a


good chance of recovering a good part of their money. This may turn out to be so, but the special managers are still investigating what additional claims there might be and, in particular, whether there has been any intermingling of the British and Gibraltar client funds. That is why it is really not possible for me to make a clearer statement now.
Many of the most distressing cases appear to involve investments placed with Barlow Clowes International. I must inform the House that here the position looks rather less encouraging. BCI's view was apparently that it was not carrying on business in this country. Accordingly, it did not seek a licence or other authorisation under the old Act. Nor has it sought authorisation under the new Act. Whether my Department had reason to believe that it, BCI, should have had a licence will have to be judged on the facts that will be covered in Sir Godfray's report. A company that is not carrying on business in Britain is not, and cannot be made, subject to our supervision, either under the old or the new legislation. As a Gibraltar-registered company, the liquidation of BCI is proceeding according to Gibraltar law. The current position is that proceedings have been taken in Gibraltar, and joint liquidators and joint receivers have been appointed. My Department is in touch in parallel with the Gibraltar authorities.
The House will know that the serious fraud office, in conjunction with the City of London police company fraud department, is also investigating Barlow Clowes Gilt Managers Ltd., BCI, and associated companies. A charge of attempting to pervert the course of justice has already been brought, and is clearly sub judice.
The volume of correspondence relating to investors dealing with the Gibraltar company, BCI, has inevitably focused attention on the role played by intermediaries, as my hon. Friend the Member for Honiton suggested, in recommending the Barlow Clowes schemes. This is an important link in the chain. If BCI is right in maintaining that it did not require a licence or authorisation, its products could not be marketed in Britain except by intermediaries which were so licensed or authorised.
It appears that in the majority of instances the intermediaries involved were members of FIMBRA, the Financial Intermediaries, Managers and Brokers Regulatory Association. None, so far as I am aware, was a licensed dealer. As FIMBRA was a recognised association of dealers under the old Act, its member firms did not require a licence and were not directly regulated by my Department. They were, however, required to comply with the rules of FIMBRA, which would have obliged them to exercise proper care before recommending investment products such as the Barlow Clowes schemes. Both FIMBRA and the Securities and Investments Board are looking closely into the relationship between Barlow Clowes and the intermediaries which recommended their products. FIMBRA has already prohibited from taking on new business the two firms which seem to have been responsible for much of the money from Britain which was placed with BCI.
Hon. Members have been pressing, tonight and previously, for me to make a statement on the question of compensation for investors in Barlow Clowes. I understand why they should press me in that way. On the general issue, it would be wrong for me—I think that this is accepted—to prejudge the findings of Sir Godfray's report. The object of the inquiry is to ascertain the facts. It would be nonsensical, having ordered the inquiry, if we were to commit ourselves in advance to a particular response on a series of, as yet, hypothetical possibilities. I know, and deeply regret, that the uncertainty of the position of investors must add to their distress, but until we have facts to go on I cannot say what the position on compensation will be, or ought to be.
I am grateful for the balance which my hon. Friends who have contributed to the debate have brought to it and for the temperate way in which they have expressed themselves. I hope that they are reassured as to the urgency with which we are addressing this matter and the concern with which we are approaching it. There is no intention to cover up anything. We have expressed our determination that all these matters should be investigated as fully as possible.

Question put and agreed to.

Adjourned accordingly at twenty-six minutes to Two o'clock.